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Rivista Italiana di Chirurgia Maxillo-Facciale 2001 December;12(3):169-75

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

The role of stenting in the endovascular treatment of acute hemorrhagic complications for neoplastic infiltration of the carotid arteries

Castellan L., Causin F., Perini S., Padula E.

From the Institute of Neuroradiology * Maxillo-Facial Surgery Department, “S. Bortolo” Hospital, Vicenza, Italy


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The carot­id rup­ture ­for neo­plas­tic infil­tra­tion is a crit­i­cal com­pli­ca­tion in ­patient ­with ­advanced malig­nant neo­plasm of ­the ­neck. We ­describe dif­fer­ent endo­vas­cu­lar treat­ments ­and a poten­tial ­role of ­the ­stents in ­patients ­with hem­or­rhage ­due to rup­ture of ­the carot­id arter­ies ­for cer­vi­cal can­cer. Three cas­es ­were ­reviewed in ­order to ­study ­the etio­log­ic fac­tors of ­the carot­id hem­or­rhag­es, ­the effi­ca­cy ­and ­the ratio­nale of ­the dif­fer­ent endo­vas­cu­lar pro­ce­dures ­and ­the out­comes. All ­the ­patients ­were pre­vi­ous­ly treat­ed ­for car­ci­no­ma of ­the ­neck. The caus­es of ­the hem­or­rhage ­were neo­plas­tic infil­tra­tion of ­the carot­id bifur­ca­tion, ­postradio­nec­ro­sis pha­ryn­goc­u­ta­ne­ous fis­tu­la ­and post­op­er­a­tive pseu­do-aneu­rysm, respec­tive­ly. After pre­lim­i­nary angio­gra­phy, endo­vas­cu­lar embol­iza­tion ­with occlu­sion of ­the carot­id bifur­ca­tion ­with bal­loons, ­coils ­and par­ti­cles, deliv­ery of cov­ered bal­loon-expand­able ­stent ­and of ­not cov­ered ­self-expand­able ­stents ­were per­formed, respec­tive­ly. All ­the pro­ce­dures ­were effi­cient ­with no com­pli­ca­tions ­and no re-bleed­ings dur­ing a ­mean fol­low-up of 24 ­months. Since ­the sur­gi­cal carot­id recon­struc­tion ­for ­advanced cer­vi­cal can­cer ­has a ­high mor­bid­ity ­rate, ­the endo­vas­cu­lar treat­ment is a ­safe ther­a­peu­tic ­option in ­these ­patients. If ­allowed by ­the ana­tom­i­cal sit­u­a­tion, ­the ­use of cov­ered ­stents ­must be pre­ferred.

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