A Systemic Review and Meta-Analysis of the Endovascular Management of Carotid Blowout Syndrome

Currently, carotid blowout syndrome (CBS) is mainly treated with endovascular treatments, including embolization and stent grafting. However, the optimal treatment strategy remains a topic of debate. This paper aims to thoroughly assess the overall efficacy of endovascular therapies for CBS and to systematically compare the clinical outcomes and complications between embolization and stent grafting.

Medline, EMBASE, and the Cochrane Library were searched from inception to April 28, 2024. The comparison between embolization and stent grafting was determined based on the primary or secondary outcomes. Recurrent bleeding and complications were the primary outcomes. Secondary outcomes included postoperative mortality and 1-year mortality. Newcastle-Ottawa scale (NOS) was used to evaluate the methodological quality of the cohort studies.

There were no randomized studies among the total of 31 studies included in the analysis, which comprised 16 single-arm studies and 15 2-arm studies and involved 1,824 patients. The NOS evaluation produced an average score of 7.19, reflecting medium to high quality across the studies. The pooled results from these cohort studies revealed a significantly higher risk of postoperative rebleeding [odds ratio (OR) = 2.18, 95% confidence interval (CI) 1.24-3.83; P = 0.01] and complications (OR = 1.91, 95% CI 1.15-3.19; P = 0.01) in the stent grafting group compared to the embolization group. However, there were no statistically significant differences in the risks of postoperative mortality (OR = 1.27, 95% CI 0.73-2.23; P = 0.40) or 1-year mortality (OR = 0.77, 95% CI 0.41-1.45; P = 0.42) between the stent grafting and embolization groups. Given that the included studies are primarily cohort studies, further prospective, multicenter research is necessary to validate these findings.

Patients with CBS in the stent grafting group demonstrated a significantly higher risk of postoperative rebleeding and complications compared to those in the embolization group. While embolization is a feasible approach for treating CBS, its long-term outcomes remain uncertain.