Treatment strategy of carotid blowout syndrome after radiotherapy for nasopharyngeal carcinoma
Objective:To investigate the treatment of internal carotid artery rupture after radiotherapy for na-sopharyngeal carcinoma.Methods:The clinical data of 7 patients with internal carotid artery rupture after radio-therapy for nasopharyngeal carcinoma from March 2020 to March 2023 were retrospectively analyzed.Results:Skull base osteonecrosis with infection occurred in 4 cases,and tumor recurrence with infection in 3 cases.DSA showed that internal carotid artery rupture was located in the internal carotid artery petrosal segment in 6 cases,and in the paravicular segment in 1 case.Balloon occlusion test(BOT)was performed in 6 patients,of which 3 passed and 3 failed.Vascular treatment included internal carotid artery embolization(4 cases),false aneurysm em-bolization 1 case(rebleeding),coated stent 1 case(rebleeding),muscle compression during operation(1 case).Pa-tients with rebleeding received high-flow bypass.Three cases developed cerebral infarction after embolization without severe sequelae after treatment,and no death occurred within 90 days.After bleeding control,all 3 pa-tients with cranial base necrosis received surgical treatment to remove the necrotic bone and tissue flap repair,and 1 patient with recurrence received gamma knife and targeted therapy,1 patient received immune and surgical ther-apy,and 1 patient received immune and targeted therapy.Conclusion:Rupture and hemorrhage of internal carotid artery after radiotherapy is related to tumor invasion,tissue injury and local infection after radiotherapy.For those caused by tumor invasion,it is recommended to sacrifice the responsible vessels.For those caused by infection,e-mergency surgery is recommended and blood vessels preserved.Emergency vascular occlusion remains a life-sav-ing option.
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