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Stent grafts in patients with carotid blowout syndrome: Outcome and antiplatelet therapy in preventive versus emergency cases
Author(s) -
Kreiser Kornelia,
Gröber Isabell,
Zimmer Claus,
Storck Katharina
Publication year - 2018
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.25388
Subject(s) - medicine , aspirin , clopidogrel , surgery , stent , perioperative , acute coronary syndrome , platelet aggregation inhibitor , ticlopidine , carotid stenting , myocardial infarction , cardiology , carotid arteries , carotid endarterectomy
Abstract Background Carotid blowout syndrome due to tumor infiltration, fistulas, and therapy‐related necrosis can occur as late as years after the treatment. Reporting our experiences with preventive and acute treatment with stent grafts and discussing different ways of antiplatelet therapy. Methods We reviewed all patients between 2010 and 2016 who underwent stent graft placement and analyzed outcome, complications, and antiplatelet regime. Results Seventeen patients were treated in 24 sessions (n = 7 threatened, n = 5 imminent, and n = 12 acute bleeding). The antiplatelet regime covered the entire range from aspirin only to loading doses of aspirin/clopidogrel, perioperative heparin, and aspirin/clopidogrel for 12 months followed by lifelong aspirin. Rare complications were not associated with the preprocedural or periprocedural but were associated with the postprocedural antiplatelet regime. Conclusion Most complications of stent graft implantations due to a carotid blowout syndrome occur postprocedurally: rare thrombotic events are linked to not taking a medication and frequent rebleedings may be reduced by an earlier reduction of dual‐antiplatelet to mono‐antiplatelet therapy.