Deconstructive versus reconstructive approach to internal carotid artery blowout in radiated nasopharyngeal carcinoma: A tertiary center experience and systematic review

Abstract

AbstractThe objective of this study was to compare the outcomes of parent artery occlusion (PAO) versus stent‐assisted reconstruction in radiated nasopharyngeal carcinoma (NPC) patients with internal carotid artery (ICA) blowouts. A retrospective review from our institution (2011–2021) and systematic review of Pubmed and Embase (1995–2022) was performed. Twenty‐eight eligible studies were identified. Eighty‐six PAOs and 37 stent‐assisted reconstructions were analyzed, including 11 PAOs and 5 stents from our institution. Stents were associated with significantly higher incidence of overall re‐bleeding (16.2% [95% CI 7.4–31.9] vs. 4.6% [95% CI 1.3–13.5], p = 0.047), delayed stroke (5.4% [95% CI 1.3–19.4] vs. 0%, p = 0.034) and reduced median survival (7.1 [95% CI 3.8–14.0] months vs. 29.0 [95% CI 9.4–63.4] months, p = 0.017) compared to PAO. There were no significant differences in terms of overall stroke, infection, extruded/migrated foreign body, and peri‐procedure death. PAO is preferred over reconstructive treatment in patients with adequate collateral circulation.