Covered Stents for the Prevention and Treatment of Carotid Blowout Syndrome BACKGROUND: Carotid blowout syndrome (CBS) is a life-threatening emergency re- sulting from compromise of the carotid artery caused by malignancy in the head and neck. OBJECTIVE: To report our experience with covered stents for the prevention or treatment of carotid blowout syndrome secondary to head and neck cancer to ascertain the safety and efficacy of this technique. METHODS: We reviewed the characteristics and outcome of all patients who under- went covered stent placement in the extracranial carotid artery in the setting of head and neck malignancy between 2006 and 2013 at the University of Miami. Patient demographics, presenting symptoms, devices used, perioperative complications, imaging, and follow-up data were reviewed. RESULTS: Seventeen carotids in 15 patients, whose ages ranged from 20 to 84 years (mean, 70.4 years), were treated with 20 covered nitinol (Viabahn Endoprosthesis, Gore, Flagstaff, Arizona) stents. Three patients were treated acutely for bleeding from carotid blowout, and 12 were treated prophylactically for threatened carotid blowout. All pa- tients were given periprocedural dual antiplatelet therapy. No thromboembolic or ischemic complications were noted. Hemorrhage after treatment occurred in 4 patients. In 2 patients, the hemorrhage was from a source not covered by the stent. CONCLUSION: The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice. KEY WORDS: Carotid blowout, Covered stent, Viabahn Neurosurgery 77:164–167, 2015 DOI: 10.1227/NEU.0000000000000738 www.neurosurgery-online.com C arotid blowout syndrome (CBS) is a life- threatening complication of head and neck malignancy. Acute bleeding from carotid blowout can be treated with surgical ligation, endovascular carotid sacrifice, or reconstruction with covered stents. A recent systematic review of CBS reported an incidence of 2.6% in 1554 patients receiving salvage radiation for head and neck cancer. 1 Our institutional bias is to treat imminent or threatened CBS as early as possible with carotid reconstruction using polytetra- fluoroethylene-covered stents. However, data supporting such a practice are limited to small case series with various results. Here, we report our experience with covered stents for the prevention or treatment of CBS secondary to head and neck cancer to ascertain the safety and efficacy of this technique. METHODS Study Design and Population This study was performed with Institutional Review Board approval at the University of Miami and Jackson Memorial hospitals. We conducted a retrospective chart review of all patients treated with covered stents for acute, imminent, or threatened CBS from January 2006 through December 2013. Threatened carotid blowout was considered when the carotid artery was encased by the tumor or when there was breakdown of the overlying wound after surgery. Patients with Brandon G. Gaynor, MD* Diogo C. Haussen, MD‡ Sudheer Ambekar, MD* Eric C. Peterson, MD* Dileep R. Yavagal, MD‡ Mohamed Samy Elhammady, MD* Departments of *Neurosurgery and ‡Neurology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida Correspondence: Mohamed Samy Elhammady, MD, University of Miami Miller School of Medicine, Department of Neurological Surgery, Lois Pope LIFE Center, 1095 NW 14th Terrace (D4-6), Miami, FL 33136. E-mail: melhammady2@med.miami.edu Received, November 27, 2014. Accepted, February 11, 2015. Published Online, March 18, 2015. Copyright © 2015 by the Congress of Neurological Surgeons. WHAT IS THIS BOX? A QR Code is a matrix barcode readable by QR scanners, mobile phones with cameras, and smartphones. The QR Code above links to Supplemental Digital Content from this article. Abbreviation: CBS, carotid blowout syndrome Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.neurosurgery-online.com). RESEARCH—HUMAN—CLINICAL STUDIES RESEARCH—HUMAN—CLINICAL STUDIES 164 | VOLUME 77 | NUMBER 2 | AUGUST 2015 www.neurosurgery-online.com Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited