Extracranial/Intracranial Vascular Bypass in the Treatment of Head and Neck Cancer ‐ Related Carotid Blowout Syndrome

Objective/Hypothesis To investigate the endovascular intervention or extracranial/intracranial (EC/IC) vascular bypass in the management of patients with head and neck cancer‐related carotid blowout syndrome (CBS). Study Design Retrospective case series. Methods Retrospective analysis of clinical data of patients with head and neck cancer‐related CBS treated by endovascular intervention and/or EC/IC vascular bypass, analysis of its bleeding control, neurological complications, and survival results. Results Thrity‐seven patients were included. Twenty‐five were associated with external carotid artery (ECA); twelve were associated with internal or common carotid artery (ICA/CCA). All patients with ECA hemorrhage were treated with endovascular embolization. Of the 12 patients with ICA/CCA hemorrhage, 9 underwent EC/IC bypass, 1 underwent endovascular embolization, and 3 underwent endovascular stenting. For patients with ECA‐related CBS, the median survival was 6 months, and the 90‐day, 1‐year, and 2‐year survival rates were 67.1%, 44.7%, and 33.6%, respectively; the estimated rebleeding risk at 1‐month, 6‐month, and 2‐year was 7.1%, 20.0%, and 31.6%, respectively. For patients with ICA/CCA‐related CBS, the median survival was 22.5 months, and the 90‐day, 1‐year, and 2‐year survival rates were 92.3%, 71.8%, and 41.0%, respectively; the estimated rebleeding risk at 1 month, 6 months, and 2 years is 7.7%,15.4%, and 15.4%, respectively. ICA/CCA‐related CBS patients have significantly longer survival time and lower risk of rebleeding, which may be related to the more use of EC/IC vascular bypass as a definite treatment. Conclusions For patients with ICA/CCA‐related CBS, if there is more stable hemodynamics, longer expected survival, EC/IC vascular bypass is preferred. Level of Evidence 4 Laryngoscope, 131:1548–1556, 2021