(A627) Safety and Efficacy of Carotid Artery Balloon Test Occlusion in Head and Neck Cancer Patients

Introduction: Advanced head and neck cancers can invade the carotid artery and lead to life-threatening complications, such as carotid blowout syndrome (CBS). Balloon test occlusion (BTO) can be useful in determining the ischemic risk of carotid sacrifice by assessing the neurological exam during temporary hemostasis and evaluating collateral circulation across the circle of Willis. Here, we aim to review the literature on the safety of carotid artery BTO and the methods utilized to improve its predictive value in head and neck cancer patients.

Methods: The study design followed the PRISMA guidelines. We conducted an electronic database search of PubMed, Web of Science, Google Scholar, and Embase. Inclusion criteria involved: patients with head and neck cancers, use of BTO rather than another occlusion test, and outcome measures of safety or efficacy. Literature reviews and meta-analyses were excluded. We screened 404 studies with two independent reviewers utilizing Covidence and included 23 studies from 1992-2022.

Results: The studies were categorized into two groups: acute (14/23) and delayed ischemic risk (9/23). Across both groups, the most common BTO complication was thromboembolic events (6/23). Other complications included neurological deficits (3/23), transient blindness (1/23), and cavernous sinus syndrome (1/23). Multiple imaging modalities were utilized to minimize hypoperfusion and complications. HMPAO-SPECT and angiography were the most commonly used and allowed for the development of scoring metrics to predict acute and delayed ischemic tolerance.

Conclusions: The evaluation of the overall safety and utility of BTO in head and neck cancer patients aims to develop a comprehensive understanding of the risks and benefits of this procedure. It can also guide diagnostic work-up before endovascular or surgical interventions for acute CBS to optimize patient outcomes.