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.

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.