Cancer Therapy& Radiation Oncology

Carotid blow out syndrome (CBOS) is a catastrophic neurovascular emergency associated with a high morbidity and mortality (M&M). The etiology of CBOS is: head and neck malignancies with tumor invasion, postoperative complications, inflammation, trauma, vasculitides, collagen diseases, and post radiation therapy for malignancies, among others. The conventional surgical management has been and is carotid artery and/or branch ligation or bypass, and is rather difficult and associated with significant M&M and could be ineffective in controlling the situation. At this time, the ideal management of this serious problem is the IR and INR endovascular: insertion of stents of ndifferent kinds (covered or uncovered, selfexpanding or balloon-expandable) and/or embolization of the carotid or vertebral arteries or branches, with temporary or permanent agents and/or devices. A permanent or temporary success is expected with stent insertion and/or embolization, or both procedures combined. We have managed many patients, not considered ideal candidates for surgery, at least during the acute phase, with stents from different manufacturers, mostly covered. In addition, we have embolized some patients as well and some other patients have had both methods. The procedures have been done in the IR suite by the IR, INR and surgeons as well, working in team, in a collaborative rather than in an adversarial manner. No major complications related to the procedures have been found. The patients have had a long-term or a temporary improvement in their condition. The emergent management of CBOS by stenting and/or embolization or both is a safe, effective and relatively easy procedure to temporarily manage these seriously ill patients. A longer follow up and many more patients studied are necessary to establish the definitive role of stenting and/or embolization in CBOS. In conclusion, the conventional surgical management of CBOS may be difficult and/or ineffective, therefore, the endovascular management is considered the first choice of therapy, at least for now, especially in clinically desperate situations.