Abstract
Purpose
Carotid blowout syndrome (CBS) is a catastrophic complication of aggressive treatment of head and neck cancer. Early detection of bleeding points with embolization is a life-saving procedure; however, some bleeding points may be difficult to identify. Our aim was to determine whether guidewire manipulation (GWM) could be used to verify bleeding point locations in patients with CBS.
Methods
Of the 92 patients with CBS referred for embolization in a 5-year period, 14 men and one woman (mean age 58 years) had bleeding points at locations that could not be definitely determined. We used GWM to verify the presence of these bleeding points. We assessed the anatomy of the ruptured arteries, technical details of GWM, and the angiographic and clinical outcomes.
Results
Bleeding points were difficult to detect because of the presence of small arterial pouches (n = 6) or multiple small arterial pouches (n = 9) in the unilateral or bilateral carotid arteries. Bleeding point locations were accurately identified using GWM in the internal carotid artery (n = 7), carotid bulb (n = 4), or common carotid artery (n = 4). Balloon-assisted GWM was applied in one patient. Fiber coils (n = 15) and/or liquid adhesives (n = 2) were used to occlude the affected artery. Endovascular management was technically successful in all patients and resulted in immediate cessation of hemorrhage without recurrence in a mean 22-month clinical follow-up.
Conclusion
GWM is a simple and effective method for verifying bleeding points in ruptured arteries and preventing erroneous occlusion by embolization.
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This study was funded in part by grants from the Taipei Veterans General Hospital (V107C-023) and the Taiwan Ministry of Science and Technology (106-2314-B-075-011).
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The authors declare that they have no conflict of interest.
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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the Taipei Veterans General Hospital Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Luo, CB., Tsuei, YS., Chang, FC. et al. Verification of bleeding points in carotid blowout syndrome using guidewire manipulation. Neuroradiology 60, 835–841 (2018). https://doi.org/10.1007/s00234-018-2044-y
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DOI: https://doi.org/10.1007/s00234-018-2044-y