2026 Poster Presentations
P493: EXTRACRANIAL-INTRACRANIAL (EC-IC) BYPASS FOR CAROTID COMPLICATIONS IN IRRADIATED HEAD AND NECK CANCER PATIENTS
Chin-Nung Liu1; Tzu-Hua Chen, MD2; Yi-Tsen Lin, MD, PhD1; Kuo-Chuan Wang, MD, PhD2; 1Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; 2Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Background: Carotid complications represent a serious sequela in patients with previously irradiated head and neck cancers. Carotid blowout syndrome, often secondary to pseudoaneurysm formation, can be fatal, whereas carotid occlusion may result in stroke-like symptoms. An extracranial–intracranial (EC–IC) bypass surgery, which harvesting a vessel graft and bypass the threatened or occlusive ICA offers a means of maintaining adequate cerebral perfusion in this high-risk population. We present a case series of patients with prior head and neck cancer treatment who developed carotid complications and subsequently underwent EC–IC bypass surgery, with emphasis on preoperative considerations and surgical planning.
Methods: We retrospectively reviewed patients who underwent EC–IC bypass between 2014 and 2025. Clinical data including cancer type and stage, presenting symptoms, vessel graft types, and recipient vessels were analyzed.
Results: Eleven patients underwent EC–IC bypass, including four bilateral cases. The mean age at surgery was 49.1 ± 10.4 years (median 50.2). All were male, with four (36%) received re-irradiation. The interval between radiotherapy and bypass surgery was 11.5 ± 8.9 years (median 10, range 1–32 years). Ten patients had a history of nasopharyngeal carcinoma and one had oropharyngeal carcinoma. Grafts included six saphenous veins and nine radial arteries. Ten grafts were anastomosed to M2 segment while 5 were to M3 segment. Two perioperative complications were recorded: one postoperative hemorrhage attributed to hyperperfusion and one intracranial abscess. A schematic of the preoperative evaluation process is presented in Figure 1 and 2.
Conclusions: In this series, re-irradiation for nasopharyngeal carcinoma appeared to be a potential risk factor for carotid complications necessitating EC–IC bypass. While most patients developed complications more than a decade after radiotherapy, earlier onset within two years was also observed. Graft selection remains a critical factor in surgical planning. Overall, EC–IC bypass is a feasible and safe option that can preserve cerebral perfusion and improve quality of life in this complex patient population.
Figure 1. Clinical management pathway for carotid complications following head and neck irradiation
Figure 2. Algorithm of vessel graft selection
