A systematic review and meta-analysis of endovascular treatment of carotid blowout syndrome

Carotid Blowout Syndrome (CBS) is a rare and life-threatening condition that necessitates prompt intervention to prevent fatal hemorrhage. This study compares the outcomes of two primary endovascular approaches: reconstructive interventions, which aim to preserve carotid artery function using stents or balloon angioplasty, and deconstructive interventions, which involve vessel occlusion to halt bleeding. A systematic review and meta-analysis were performed by searching multiple databases for relevant studies published from January 2000 to August 2023. A total of 28 studies involving 554 patients were included, with 214 undergoing reconstructive interventions and 340 receiving deconstructive procedures. Results indicated an overall 30-day mortality rate of 10%, with no significant difference between intervention types. However, the reconstructive group exhibited higher rates of rebleeding beyond 24 h and severe technical complications. While complication rates decreased over time, an increase in long-term mortality was noted for both approaches. These findings highlight the need for enhanced strategies in CBS management, particularly in reducing long-term mortality and addressing complications associated with reconstructive interventions. Carotid blowout syndrome (CBS) is a rare and life-threatening condition that requires prompt intervention to prevent fatal hemorrhage. Two primary endovascular approaches are used: reconstructive interventions, which aim to preserve the carotid artery's function through stenting or balloon angioplasty, and deconstructive interventions, which focus on vessel occlusion to stop bleeding. This study aimed to compare these methods regarding prognosis, complication rates, and outcome trends over time. A systematic review and meta-analysis were conducted, searching multiple databases for studies published from January 2000 to August 2023. Eligible studies included randomized controlled trials and observational studies reporting outcomes and complications of endovascular interventions for CBS. The analysis included 28 studies with a total of 554 patients, of whom 214 received reconstructive interventions and 340 underwent deconstructive procedures. The overall 30-day mortality rate was 10%, with no significant difference between the two intervention types. However, the reconstructive group showed a higher incidence of rebleeding beyond 24 h and severe technical complications. While complication rates decreased over time, long-term mortality increased. This study found no significant differences between reconstructive and deconstructive endovascular interventions in most aspects of CBS prognosis. However, reconstructive approaches, particularly those involving stents, were associated with a higher risk of rebleeding beyond 24 h and severe technical complications. Additionally, the data suggest an increase in long-term mortality rates for both methods, highlighting areas for potential improvement in CBS management and intervention strategies. Compared to previous meta-analyses, this study includes more recent and comprehensive literature, evaluating a wider range of prognostic indicators, such as transient ischemic attacks, infection rates, late-stage rebleeding, and severe procedural complications. These findings provide an updated and nuanced understanding of the risks and outcomes associated with CBS interventions, offering valuable insights that could guide clinical decision-making and future research on optimal intervention strategies.