Interventional Treatment Strategies for Carotid Blowout Syndrome After Radiotherapy for Nasopharyngeal Carcinoma.

Abstract

Background: Carotid blowout syndrome (CBS) is a life-threatening complication that can occur after radiotherapy in nasopharyngeal carcinoma (NPC) patients, resulting in catastrophic hemorrhage. Endovascular treatments, including coil embolization and stent grafting, have become standard options for managing CBS. Recent studies suggest that individualized approaches based on aneurysm location and vascular condition may further reduce recurrence and complications. This study aims to evaluate the efficacy, safety, and outcomes of these treatments in NPC patients with CBS.

Methods: A retrospective analysis was conducted on 46 NPC patients who developed CBS following radiotherapy and underwent endovascular intervention at Zhongshan People's Hospital between January 2016 and July 2023. Outcomes such as immediate hemostasis, rebleeding rates, complications, and 1-year survival were analyzed.

Results: Among the 46 patients, 29 received coil embolization and 17 underwent stent grafting. Immediate hemostasis was achieved in all cases (100%). The 1-year rebleeding rate was 8.6% (4/46), and the overall complication rate was 8.6% (4/46), with cerebral infarctions being the primary concern. Coil embolization is associated with lower rebleeding rates, while stent grafting preserves arterial patency better. The 1-year survival rate was 89.1% (41/46).

Conclusion: Endovascular interventions, including coil embolization and stent grafting, are effective in managing CBS in NPC patients after radiotherapy. Future research should focus on refining patient selection criteria and optimizing long-term outcomes.