Article Figures & Data
Figures
- Fig 1.
A 52-year-old man with a history of oropharyngeal cancer. A, MIP CTA imaging performed after bleeding was controlled by local packing shows contrast extravasation (arrow) from the common carotid artery near the bifurcation. B, Source image shows an exposed common carotid artery (arrows) surrounded by necrosis. C, DSA done immediately after CTA does not show contrast extravasation. However, the possibility of a further tamponade effect after CTA cannot be excluded in this case.
- Fig 2.
A 42-year-old man with a history of nasopharyngeal cancer. A, MIP CTA image shows a pseudoaneurysm (arrow) at the right occipital artery. B, Oblique reformatted image shows the pseudoaneurysm surrounded by necrotic tissue (star). Half of the circumference of the right internal carotid artery (large arrow) is exposed to the necrotic tissue, and the unexposed vertebral artery (small arrow) is close to the necrotic margin. C, DSA confirms the pseudoaneurysm of the occipital artery. The pseudoaneurysm is embolized with coils. At 64 days after treatment, another blowout occurs. D, Oblique reformatted CTA image shows a newly developed pseudoaneurysm (large arrow) with extravasation from the right vertebral artery (small arrow). E, DSA confirms the diagnosis.
- Fig 3.
Kaplan-Meier survival curves with pair-wise log-rank test show group 1 (blue, no pseudoaneurysm/extravasation/exposed artery on CTA) has the best survival rate, followed by group 2 (green, with pseudoaneurysm/extravasation/exposed artery on CTA and treated by permanent artery occlusion), and the worst survival is noted in group 3 (red, with pseudoaneurysm/extravasation/exposed artery on CTA but not treated by permanent artery occlusion).
Tables
Imaging Finding All CTA First CTA Second CTA Necrosis Percentage (ratio) 94% (31/33) 93% (27/29) 100% (4/4) 95% CI 0.79–0.99 0.77–0.99 0.54–1.00 Viable perivascular tumor Percentage (ratio) 67% (22/33) 66% (19/29) 75% (3/4) 95% CI 0.50–0.80 0.47–0.80 0.29–0.97 Pseudoaneurysm Percentage (ratio) 58% (19/33) 59% (17/29) 50% (2/4) 95% CI 0.41–0.73 0.40–0.75 0.15–0.85 Contrast extravasation Percentage (ratio) 30% (10/33) 24% (7/29) 75% (3/4) 95% CI 0.17–0.47 0.12–0.42 0.29–0.97 Exposed artery Percentage (ratio) 73% (24/33) 69% (20/29) 100% (4/4) 95% CI 0.56–0.85 0.51–0.83 0.54–1.00 - Table 2:
Interobserver agreement of CTA findings in 29 patients with carotid blowout syndrome
Imaging Finding κ 95% CI Necrosis 0.785 0.38–1.00 Viable perivascular tumor 0.864 0.68–1.00 Pseudoaneurysm 0.942 0.83–1.00 Contrast extravasation 0.932 0.80–1.00 Exposed artery 0.807 0.60–1.00 - Table 3:
Comparison of the diagnosis between the 23 studies of CTA and conventional angiography in 20 patients with carotid blowout syndrome
CTA Pseudoaneurysm Contrast Extravasation Viable Perivascular Tumor Necrosis Exposed Artery Positive Negative Positive Negative Positive Negative Positive Negative Positive Negative Positive results on DSA 17 1 6 1 5 0 0 0 0 0 Negative results on DSA 0 5 4 12 11 7 23 0 20 3
