Introduction Acute carotid blowout syndrome (aCBS) commonly refers to a rare emergency caused by a rupture of the extracranial carotid artery or its branches, resulting in rapid and profuse bleeding from the cervical carotid arteries. There is an equally dangerous but less common entity called acute intracranial internal carotid artery blowout syndrome (ICABS), which occurs iatrogenically during transnasal surgeries or after radiotherapy but can also be secondary to trauma or tumor invasion.
Objective This study aims to perform a systematic review of the clinical predictors for iatrogenic ICABS postoperative course.
Methods We searched in PubMed, Embase, Scopus, Web of Science, and Google Scholar until December 23, 2022. The risk of bias (RoB) and quality of the studies were assessed using the Joanna Briggs Institute (JBI) assessment tool for case series and case reports. Primary outcomes were overall success rate and mortality at last follow-up, while secondary outcomes were postprocedural complications rate and death cause. A logistic multivariate regression was performed to identify predictors of mortality and postoperative complications.
Results A total of 23 studies with 53 pooled patients were included in the analysis. Predominant age was 51.2 ± 16.14. Most frequent initial diagnosis was head and neck cancer (53%), mainly referring to cases of nasopharyngeal carcinoma. Three main groups of iatrogenic interventions were reported: radiotherapy (36%), surgery (42%), and endovascular treatment (4%). The JBI risk of bias assessment revealed demographic data and site demographic information, as well as description of adverse events and take away lessons, as the most neglected components in case series and case reports, respectively. Reported overall success were achieved as devascularization (53%) and revascularization (28%) procedures. The most frequent lesion was a pseudoaneurysm (42%) located on the petrous segment (45%) of the internal carotid artery. After running the logistic regression, the only significant clinical predictor identified for postoperative complications was female gender (OR = 3.25 (1.06 - 9.97), p = 0.039).
Conclusion Despite being a iatrogenic injury, ICABS is seldom reported on literature as case series and case reports with serious methodological mishaps. Most frequently after surgical procedures involving transnasal endoscopic resections. Nevertheless, due to its usual intraoperative occurrence, the major hemorrhage can be rapidly treated by endovascular procedures. More primary studies are needed to identify further predictors of postoperative complications and mortality.
Disclosures E. Luther: None. F. Terry: None. J. Sequeiros: None. S. Bhatia: None. C. Quispe-Vicuna: None. K. Zullo: None. G. Saal-Zapata: None. J. Burns-Martin: None. N. Goyal: None. R. Starke: None.
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