Prognosis of patients with carotid blowout syndrome in the era of endovascular interventions

Objective. To analyse the prognosis of carotid blowout syndrome (CBS) after endovascular interventions in patients with head and neck cancer. Methods. We conducted a retrospective study at a tertiary centre (2000-2019), including demo-graphics, medical history, treatment details, and outcomes of CBS. Results. Among 44 patients with CBS (32 males, 12 females; mean age 65 ± 14 years), squamous cell carcinoma histotype and laryngeal localisation were most common, with 84% having advanced-staged disease. Significant risk factors included prior surgery (70%), neck dissection (48%), radiation (55%), and chemotherapy (66%). Pharyngocutaneous fistula and tracheostomy were present in 32% and 57% of cases, respectively. Radiological findings showed threatened bleeding (62%), sentinel bleeding (11%), and acute rupture (27%). Endovascular treatment achieved haemostasis in 95% of cases, with an 11% rate of acute ischaemic complications. Six-month survival was 28%, with 66% of deaths due to disease progression. Recurrent bleeding occurred in 16% of cases. Conclusions. CBS is a severe complication with a high risk of rebleeding. Endovascular interventions effectively manage bleeding with low rates of com-plication.