Endovascular Management of Post-Irradiated Carotid Blowout Syndrome in Patients with Lower Neck Cancers.

OBJECTIVE: Lower neck cancers (LNCs) include specific tumour types and have some different vascular supply or collaterals from other head and neck cancers. This prospective study evaluated the outcome of endovascular management of post-irradiated carotid blowout syndrome (PCBS) in patients with LNC by comparing reconstructive management (RE) and deconstructive management (DE). METHODS: This was a single centre, prospective cohort study. Patients with LNC complicated by PCBS between 2015 and 2021 were enrolled for RE or DE. RE was performed by stent graft placement covering the pathological lesion and preventive external carotid artery (ECA) embolisation without balloon test occlusion (BTO). DE was performed after successful BTO by permanent coil or adhesive agent embolisation of the internal carotid artery (ICA) and ECA to common carotid artery, or ICA occlusion alone if the pathological lesion was ICA only. Cross occlusion included the proximal and distal ends of the pathological lesion in all patients. Re-bleeding events, haemostatic period, and neurological complications were evaluated. RESULTS: Fifty-nine patients (mean age 58.5 years; 56 male) were enrolled, including 28 patients undergoing RE and 31 patients undergoing DE. Three patients originally grouped to DE were transferred to RE owing to failed BTO. The results of RE vs. DE were as follows: rebleeding events, 13/28 (46%) vs. 10/31 (32%) (p = .27); haemostatic period, 9.4 ± 14.0 months vs. 14.2 ± 27.8 months (p = .59); neurological complication, 4/28 (14%) vs. 5/31 (16%) (p = .84); and survival time, 11.8 ± 14.6 months vs. 15.1 ± 27.5 months (p = .61). CONCLUSION: No difference in rebleeding risk or neurological complications was observed between the DE and RE groups. RE could be used as a potential routine treatment for PCBS in patients with LNC.

Tumefactive Demyelination Lesions: Report on three cases.

PURPOSE: Tumefactive demyelination (TD) lesion and its subtype Balo's concentric sclerosis (BCS), are rare manifestations of central nervous system demyelinating disease. Because of its rarity, physicians might hesitate in reaching a diagnosis or initiating steroid pulse therapy. This study aims at pinpointing the key neuroimaging features to distinguish TD lesions from surgical conditions, and illustrating the clinical outcomes of patients with TD lesions. CASE REPORT: Two of the three patients had solitary TD lesions, one 47-year-old man presenting with newly onset seizure and another 54-year-old women suffering from progressive hemiparesis. The male patient underwent craniotomy for mass excision without further steroid therapy, while the female patient received methylprednisolone pulse therapy only. Both patients remained free of clinical and radiological relapses over the past 6-7 years, leading to the diagnosis of clinically isolated syndrome. The third case is a 30-year-old woman with subacute onset of dysarthria and hemiparesis. She had two BCS lesions along with other demyelinating lesions in the juxtacortical and periventricular regions, cerebellar peduncles, and spinal cord, fulfilling dissemination in time and space. Her neurological deficits resolved after pulse therapy, and she received long-term disease modifying therapy for multiple sclerosis. CONCLUSION: This study underscores the diverse neuroimaging and clinical presentations of patients with TD lesions, and emphasizes the importance of clinical vigilance regarding this rare condition.

Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial carotid artery and its branches: Comparison of the Wingspan stent versus the Credo stent.

BACKGROUND: Despite the widespread use of the Wingspan stent system for treating severe medically refractory intracranial artery stenosis (SMR-ICAS), a new Credo stent system was approved because it could integrate stent delivery within the balloon catheter. However, the therapeutic outcomes of these two systems have not been compared. This preliminary study aimed to compare the results of percutaneous angioplasty and stenting (PTAS) in SMR-ICAS patients treated with either Wingspan or Credo stents within the anterior circulation. METHODS: SMR-ICAS patients with more than 70% stenosis in the anterior circulation who underwent PTAS using either the Wingspan or Credo stent system were analyzed. We evaluated the technical success, safety, and outcomes of the two stent systems. RESULTS: A total of 29 patients were analyzed, including 17 patients treated with Wingspan stents and 12 with Credo stents. The outcomes of the Wingspan stent vs. Credo stent were as follows: technical success (16/17 [94%] vs. 11/12 [92%], p = 1.00); periprocedural intracranial hemorrhage (2/17 [12%] vs. 0/12 [0%], p = 0.50); silent embolic ischemic lesions on peri-procedural MRI (13/17 [76%] vs. 7/12 [58%], p = 0.42); and significant (more than 50%) in-stent restenosis in one year (4/17 [24%] vs. 2/12 [17%], p = 1.00). No recurrent stroke or mortality was noted within 30 days after the procedures or during the one-year follow-up period. CONCLUSION: The technical success, safety, and outcomes of the Credo stent system were comparable to those of the Wingspan stent system in the management of SMR-ICAS patients. Further large-scale studies are warranted to substantiate these findings.