Prognostic Outcomes Following Endovascular Management for Carotid Blowout Syndrome: A Multi‐Institutional Observational Cohort Study

BACKGROUND: Carotid blowout syndrome (CBS) is a life-threatening complication of head and neck cancer (HNC). This study evaluated clinical outcomes and prognostic factors in patients with HNC who presented to the emergency department (ED) with CBS and underwent endovascular management. METHODS: We conducted a retrospective, multi-institutional observational study across four hospitals in Taiwan from January 1, 2011, to December 31, 2023. Adult patients with HNC who presented to the ED with bleeding suggestive of CBS on computed tomography angiography underwent endovascular therapy and had the diagnosis confirmed by digital subtraction angiography were included. The primary endpoint was in-hospital mortality. Independent prognostic factors were identified using multivariable logistic regression, and a predictive nomogram was constructed and internally validated by bootstrap resampling. RESULTS: A total of 348 patients were included. Most were male (93.7%), had Stage IV disease (74.7%), and were treated with arterial embolization (93.4%). In-hospital mortality occurred in 57 patients (16.4%). The estimated 30-day and 1-year survival rates were 84.8% and 51.7%, respectively. In multivariable analysis, vasopressor use (odds ratio [OR], 6.54), failed hemostasis (OR, 4.68), tracheostomy status (OR, 2.04), multivessel involvement (OR, 1.98), and lower systolic blood pressure (OR, 0.99 per mmHg) were independently associated with in-hospital mortality. The nomogram showed moderate discrimination with a C-statistic of 0.73. CONCLUSIONS: Among patients with HNC presenting to the ED with CBS and undergoing endovascular management, in-hospital mortality remained substantial. A nomogram incorporating readily available clinical and imaging variables may assist early risk stratification after ED presentation.