The Clinical Outcome of Carotid Blowout Syndrome Showing Non-bleeding Angiography

• Published in: Cardiovascular and interventional radiology Vol. 47; no. 7; pp. 955 - 961
• Main Authors: Lee, Bo-Ching, Hu, Yung-Ching, Lin, Yen-Heng, Chen, Ya-Fang, Hsieh, Hong-Jen, Lee, Chung-Wei
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2024; Springer Nature B.V
• Subjects: Aged; Angiography; Angiography, Digital Subtraction - methods; Bleeding; Cardiology; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - therapy; Clinical Investigation; Embolization; Embolization (arterial); Embolization, Therapeutic - methods; Extravasation; Female; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Imaging; Irregularities; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Observational studies; Patients; Pseudoaneurysm; Radiology; Retrospective Studies; Sex; Statistical analysis; Treatment Outcome; Tumors; Ultrasound; Human; Head and neck cancer; Carotid blowout syndrome; Angiography
• ISSN: 0174-1551; 1432-086X; 1432-086X
• DOI: 10.1007/s00270-024-03723-y

Objective Patient with carotid blowout syndrome (CBS) may demonstrated non-bleeding digital subtraction angiography (DSA) without identifying pseudoaneurysm or contrast extravasation. Our objective is to evaluate the clinical outcomes for this specific subset of patients. Materials and Methods A retrospective observational study was conducted on 172 CBS patients who received DSA for evaluation of transarterial embolization (TAE) between 2005 and 2022, of whom 19 patients had non-bleeding DSA and did not undergo TAE. Results The age (55.2 ± 7.3 vs. 54.8 ± 11.1), male sex (17/19 vs. 135/153), tumor size (5.6 ± 2.4 vs. 5.2 ± 2.2), cancer locations were similar ( P  > 0.05) between both groups; except for there were more pseudoaneurysm/active bleeding (85.6% vs. 0%) and less vascular irregularity (14.4% vs. 94.7%) in the TAE group ( P  < 0.001). In the multivariable Cox regression model adjusting for age, sex, and tumor size, non-bleeding DSA group was independently associated with recurrent bleeding compared to TAE group (adjusted hazard ratio = 3.5, 95% confidence interval: 1.9–6.4, P  < 0.001). Furthermore, the presence of vascular irregularity was associated with segmental recurrent bleeding (adjusted HR = 8.0, 95% CI 2.7–23.3, P  < 0.001). Conclusion Patient showing non-bleeding DSA thus not having TAE had higher risk of recurrent bleeding, compared to patient who received TAE. Level of Evidence Level 4, Case Series.