Comparison of Prophylactic Endovascular Treatments for Threatened or Impending Internal/Common Carotid Artery Blowout Syndrome.

Background and purpose: The outcomes of prophylactic endovascular interventions for patients facing threatened or impending carotid blowout syndrome (CBS) involving the ICA/common carotid artery (CCA) have not been extensively elucidated. We aimed to delineate the specific treatment outcomes for this group of patients.

Materials and methods: We retrospectively enrolled 109 patients with threatened or impending CBS of the ICA/CCA between 2006 and 2023. Patients were categorized into group 1 (no intervention for ICA/CCA, n=43), group 2 (ICA/CCA embolization, n=36), or group 3 (ICA/CCA stent placement, n=30). ANOVA and Cox regression analyses were employed to evaluate basic characteristics and the rates of recurrent bleeding, overall survival, and major complications.

Results: Age (56.8 ± 8.7 versus 54.3 ± 11.6 versus 56.6 ± 9.2), male sex (39/43 versus 33/36 versus 26/30), tumor size, and type of blowout were similar (P > .05) among groups. Tumor location (P < .001) and presence of air-containing necrosis on CT/MRI before transarterial embolization (P = .001) varied between groups. Cox regression analysis adjusted for age and sex revealed group 2 had a lower risk of recurrent bleeding than group 1 (adjusted hazard ratio [HR], 0.22; 95% CI: 0.10-0.47; P < .001) and group 3 (0.41; 95% CI: 0.17-0.96; P = .042), but a higher risk of acute stroke (P = .016). Group 2 had higher overall survival than groups 1 and 3 (0.55; 95% CI: 0.31-0.96; P = .036).

Conclusions: In threatened or impending CBS of the ICA/CCA, prophylactic embolization was associated with a lower risk of recurrent bleeding but a higher risk of acute stroke compared with ICA/CCA stent placement or no intervention.