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Volume 47, Issue 5 , Pages 936-945 , May 2008

Patients with head and neck cancers and associated postirradiated carotid blowout syndrome: Endovascular therapeutic methods and outcomes

Feng-Chi Chang, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Reprint requests: Feng-Chi Chang, Department of Radiology, Taipei Veterans General Hospital, 201 Shih-Pai Rd, Sec 2, Taipei, Taiwan 11217 ROC.
Jiing-Feng Lirng, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
Chao-Bao Luo, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
Shuu-Jiun Wang, MD
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, National Yang Ming University, Taipei, Taiwan.
Hsiu-Mei Wu, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
Wan-Yuo Guo, MD, PhD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
Michael Mu Huo Teng, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
Cheng-Yen Chang, MD
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan

Received 14 September 2007 ,Accepted 11 December 2007.

A, Left carotid angiogram in patient 10 of the reconstructive group showed only slight stenosis in the common carotid artery (grade 0, arrow). B, Contrast-enhanced axial computed tomography (CT) of th

A, Left carotid angiogram in patient 10 of the reconstructive group showed only slight stenosis in the common carotid artery (grade 0, arrow). B, Contrast-enhanced axial computed tomography (CT) of the neck revealed a necrotic sinus tract (arrowheads) close to the left common carotid artery (arrow). C, Reconstructive CT angiography (curved multiplanar reformatted images) of the left carotid artery 1 month later showed patency of the stent grafts. D, Four months later, obvious distal marginal stenosis was noted (arrowheads). Large area of soft tissue necrosis and ulceration (arrows) surrounding the stent grafts caused “floating” of left carotid artery (long arrows).
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A, Right carotid angiograms in patient 8 of the deconstructive group showed a ruptured internal carotid artery with active extravasation (grade 3, arrows). B, Cross occlusion was performed with deploy

A, Right carotid angiograms in patient 8 of the deconstructive group showed a ruptured internal carotid artery with active extravasation (grade 3, arrows). B, Cross occlusion was performed with deployment of two balloons distal and proximal to the pathologic lesions (arrows). A mixture of liquid adhesives was injected in the internal carotid artery between the 2 balloons (arrowheads).
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Graph shows correlation of clinical severity (groups: acute, impending, and threatened) with angiographic severity (grades 0, 1, 2, and 3).

Graph shows correlation of clinical severity (groups: acute, impending, and threatened) with angiographic severity (grades 0, 1, 2, and 3).
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