Carotid Artery Reconstruction With Endovascular Covered Stents: An Innovative Strategy to Avoid Interruption of Carotid Blood Flow.

Abstract

Carotid artery reconstruction is the preferred approach for treating head and neck cancer involving carotid artery (HNC-CA). While current techniques often utilize various autologous or synthetic materials for reconstruction, they pose risks such as intraoperative carotid blood flow interruption and postoperative anastomotic thrombosis. Here, we report a carotid artery reconstruction based on endovascular covered stent (CAR-ECS), which uses an endovascular covered stent implantation (ECSI) technique that does not require intraoperative interruption of carotid blood flow and avoids vascular anastomotic maneuvers. Between June 2019 and December 2020, 18 patients with HNC-CA underwent the CAR-ECS surgery. ECSI, tumor resection, and carotid artery reconstruction were successfully performed. There were no cases of carotid blowout syndrome, neurologic dysfunction, or perioperative death. Stenotic vessel internal diameter due to tumor invasion increased from 5.40 ± 1.31 mm to 7.32 ± 0.68 mm (p < 0.05). During a mean follow-up period of 11.7 months (range: 5-22 months), the 1-year overall survival rate was 61.31%, with a median survival time of 15.0 months (95% CI: 7.6-22.4). The locoregional recurrence rate was 33.3%, and the distant metastasis rate was 22.2%. In this study, we propose a novel carotid artery reconstruction and demonstrate the safety and reliability of CAR-ECS in reducing surgical risk and safeguarding patient prognosis.