Clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion.

BACKGROUND: We aimed to assess the clinical efficacy of bypass grafting in recurrent nasopharyngeal carcinoma patients with internal carotid artery invasion. METHODS: A retrospective analysis was performed involving 51 patients either operated by bypass grafting (n = 22) or treated with repeated chemo-radiotherapy (n = 29). RESULTS: Four patients in the bypass grafting group died 3-5 months after the operation due to epistaxis and pulmonary infection (4/22, 18.2%), and three more patients exhibited a modified Rankin Scale (mRS) ≥ 2 during the follow-up (3/22, 13.6%). In the repeated chemo-radiotherapy group, 8 patients died (8/29, 27.6%), including seven patients dying within 2-3 months due to epistaxis and pulmonary infection (7/29, 24.1%). One more patient died of epistaxis after 9 months. The difference in mortality between the two treatment groups within 3 months of treatment was statistically significant (P = 0.038). CONCLUSIONS: Cerebrovascular reconstruction after detailed collateral flow assessment is an effective treatment for recurrent NPC patients with internal carotid artery invasion.

'Y'-Shaped Palmar Common Digital Artery Interposition Bypass in the Treatment of an Infantile M2 Large Aneurysm and Literature Review.

OBJECTIVE: Both craniotomy and interventional embolization are difficult and risky to treat complex middle cerebral artery (MCA) aneurysms in infants. Trapping with revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled alone. METHOD: We describe a technical method using revascularization with a natural Y-shaped palmar common digital artery interposition graft that provides a normal variation for a complex MCA aneurysm in an infant with intracerebral hemorrhage at 37 days of age. Conservative treatment was performed at that time. Seven months later, the patient was re-admitted to the hospital and was confirmed a large aneurysm in the M2 segment of the right MCA by cerebral angiography. A natural artery palmar common digital artery Y-graft was used as the graft and anastomosed to the M2 and both M3 trunks. RESULT: The symptoms improved after surgery, and the mRS score of the patient was 1 after 5 years of follow-up. CONCLUSION: The palmar common digital artery can be an option for intracranial revascularization bypass in complex intracranial aneurysms.

Survival analysis of a comprehensive treatment strategy for internal carotid artery blowout syndrome by nasopharyngeal carcinoma.

OBJECTIVE: To retrospectively analyze the comprehensive treatment strategy for internal carotid artery blowout syndrome (CBS) by nasopharyngeal carcinoma (NPC). METHODS: Of the 311 patients of NPC with carotid artery blowout syndrome admitted at our center from April 2018 to August 2022, 288 were enrolled. RESULTS: The patients were divided into two groups: treatment group (266 cases) and control group (22 cases). After comprehensive treatment, the survival rate of the treatment group was significantly higher than that of the control group, especially within 6 months to the 1 year. Preventive intervention for CBS I type may have considerable benefits. And in the long run, this treatment strategy did not significantly increase the incidence of stroke in the treatment group. CONCLUSION: The comprehensive treatment strategy for ICA-CBS of patients with NPC significantly reduced the mortality of asphyxia due to epistaxis, reduced the incidence of CBS during nasal endoscopy, and finally improved survival rate.

Rapid contrast-induced encephalopathy after a small dose of contrast agent: illustrative case.

BACKGROUND: Contrast-induced encephalopathy is a rare complication of cerebral angiography with only few cases reported to date. This paper reports on contrast-induced encephalopathy mimicking meningoencephalitis following cerebral angiography with iopromide, a subhypertonic nonionic contrast agent. OBSERVATIONS: A 50-year-old woman underwent cerebral angiography for assessment of recurrent nasopharyngeal carcinoma with invasion of internal carotid artery. The patient experienced symptoms including a disturbance of consciousness, seizures, frequent blinking, and stiffness in the extremities immediately after angiography of the left common carotid artery using iopromide (4 ml/s, total 6 ml). Computed tomography scans of the brain showed no obvious abnormalities, whereas brain magnetic resonance imaging showed swelling of the left cerebral cortex without signs of ischemia or hemorrhage. The patient was treated with intravenous rehydration, mannitol dehydration, and other supportive treatment. With this treatment, neurological status progressively improved, with complete resolution of symptoms at day 10. LESSONS: This observation highlights that even a small dose of subhypertonic nonionic contrast agent can rapidly induce contrast encephalopathy.

Comprehensive Treatment Strategy for Internal Carotid Artery Blowout Syndrome Caused by Nasopharyngeal Carcinoma.

OBJECTIVE: To evaluate a treatment strategy for internal carotid artery blowout syndrome caused by nasopharyngeal carcinoma. STUDY DESIGN: A retrospective analysis of a case series was performed. SETTING: Carotid blowout syndrome is a catastrophic complication caused by malignant tumor of the skull base. METHODS: A retrospective analysis based on 69 patients with internal carotid artery blowout syndrome admitted to our center between April 2018 and January 2020 was performed. The patients were divided into 2 groups: an EBBA (internal carotid artery embolization + bypass based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology [ASITN/SIR]) group and an embolization/stent group. The follow-up time was 6 to 9 months. RESULTS: In the EBBA group, 41 patients (41/49, 83.7%) survived. Forty patients had a satisfactory quality of life after 3 months. No death occurred within 3 months. Nonoperative death occurred in 8 cases (8/49, 16.3%). The rate of mortality and disability was 18.4% (9/49). In the embolization/stent group, 16 patients (16/20, 80%) survived. Nonoperative death occurred in 4 cases (4/20, 20%), 3 of which occurred within 1 to 3 months. Four cases reported Modified Rankin Scale ≥2 after 3 months. The rate of mortality and disability was 40% (8/20). CONCLUSION: A comprehensive revascularization strategy for internal carotid artery (ICA) embolization and intracranial and extracranial bypass grafting based on ASITN/SIR score for ICA blowout syndrome patients not only can prolong the patient survival but also greatly improve the survival probability and quality of life as well as reduce their rate of mortality or disability.