Impact of Preoperative Embolization on Carotid Body Tumor Surgery

Published:March 02, 2022DOI:


      • There is no consensus on preoperative CBTE.
      • CBTE has no effect directly on neurological and vascular complications.
      • CBTE significantly reduces the amount of intraoperative bleeding.


      The aim of this study is to investigate the effect of preoperative carotid body tumor embolization (CBTE) on the amount of bleeding, and vascular and neurological complications in carotid body tumors.


      Fifty patients treated for 51 carotid body tumors in 2 clinics, between 2005 and 2020, were evaluated. Polyvinyl alcohol embolization of the carotid body tumor was performed in 23 patients before the surgical excision. The results were compared with the remaining 28 patients, in whom CBTE was not performed, in terms of neurological complications, requirement of additional vascular interventions, bleeding amount, and length of hospital stay.


      Mean bleeding amount was significantly lower in the CBTE group (406–217 mL, P < 0.05). Median erythrocyte suspension transfusion was significantly lower in the CBTE group (0.3 units vs. 1.1 units, P < 0.05). Neurological deficits developed in a total of 13 patients: 6 in the CBTE group and 7 in the non-CBTE group, in the early postoperative period (P = 0.90). No significant difference was observed between the groups in terms of additional vascular interventions and length of hospital stay (P = 0.79 and P = 0.61).


      Carotid body tumors are rarely encountered tumors. However, their surgical excision is challenging for surgeons regarding intraoperative and postoperative bleeding. This study demonstrates that preoperative CBTE significantly reduces the amount of bleeding, especially in Shamblin type II/III tumors.
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        • Dorobisz K.
        • Dorobisz T.
        • Temporale H.
        • et al.
        Diagnostic and therapeutic difficulties in carotid body paragangliomas, based on clinical experience and a review of the literature.
        Adv Clin Exp Med. 2016; 25: 1173-1177
        • Baysal B.E.
        • Myers E.N.
        Etiopathogenesis and clinical presentation of carotid body tumors.
        Microsc Res Tech. 2002; 59: 256-261
        • Dimakakos P.
        • Kotsis T.
        Carotid body paraganglioma: review and surgical management.
        Eur J Plast Surg. 2001; 24: 58-65
        • Jackson R.S.
        • Myhill J.A.
        • Padhya T.A.
        • et al.
        The effects of preoperative embolization on carotid body paraganglioma surgery: a systematic review and meta-analysis.
        Otolaryngol Head Neck Surg. 2015; 153: 943-950
        • Bland J.M.
        • Altman D.G.
        Measuring agreement in method comparison studies.
        Stat Methods Med Res. 1999; 8: 135-160
        • Budincevic H.
        • Piršic A.
        • Bohm T.
        • et al.
        Carotid body tumor as a cause of stroke.
        Intern Med. 2016; 55: 295-298
        • Ropper A.
        • Brown R.
        Carotid Body Tumor (Paraganglioma). Adams and Victor’s Principles of Neurology.
        8th ed. McGraw-Hill, New York2005: 574
        • White J.B.
        • Link M.J.
        • Cloft H.J.
        Endovascular embolization of paragangliomas: a safe adjuvant to treatment.
        J Vasc Interv Neurol. 2008; 1: 37
        • Kakkos S.K.
        • Reddy D.J.
        • Shepard A.D.
        • et al.
        Contemporary presentation and evolution of management of neck paragangliomas.
        J Vasc Surg. 2009; 49: 1365-1373.e2
        • Economopoulos K.P.
        • Tzani A.
        • Reifsnyder T.
        Adjunct endovascular interventions in carotid body tumors.
        J Vasc Surg. 2015; 61: 1081-1091.e2
        • Kruger A.J.
        • Walker P.J.
        • Foster W.J.
        • et al.
        Important observations made managing carotid body tumors during a 25-year experience.
        J Vasc Surg. 2010; 52: 1518-1523
        • Gad A.
        • Sayed A.
        • Elwan H.
        • et al.
        Carotid body tumors: a review of 25 years experience in diagnosis and management of 56 tumors.
        Ann Vasc Dis. 2014; 7: 292-299
        • Torrealba J.I.
        • Valdes F.
        • Krämer A.H.
        • et al.
        Management of carotid bifurcation tumors: 30-year experience.
        Ann Vasc Surg. 2016; 34: 200-205
        • Robertson V.
        • Poli F.
        • Hobson B.
        • et al.
        A systematic review and meta-analysis of the presentation and surgical management of patients with carotid body tumours.
        Eur J Vasc Endovasc Surg. 2019; 57: 477-486
        • Baharoon A.H.
        • Al-Mekhlafi M.A.
        • Jamjoom R.A.
        • et al.
        Carotid body tumor with skull base extension.
        Am J case Rep. 2017; 18: 1153
        • Power A.H.
        • Bower T.C.
        • Kasperbauer J.
        • et al.
        Impact of preoperative embolization on outcomes of carotid body tumor resections.
        J Vasc Surg. 2012; 56: 979-989
        • Texakalidis P.
        • Charisis N.
        • Giannopoulos S.
        • et al.
        Role of preoperative embolization in carotid body tumor surgery: a systematic review and meta-analysis.
        World Neurosurg. 2019; 129: 503-513.e2
        • Bolcato M.
        • Russo M.
        • Trentino K.
        • et al.
        Patient blood management: the best approach to transfusion medicine risk management.
        Transfus Apher Sci. 2020; 59: 102779
        • D'Ayala M.
        • Huzar T.
        • Briggs W.
        • et al.
        Blood transfusion and its effect on the clinical outcomes of patients undergoing major lower extremity amputation.
        Ann Vasc Surg. 2010; 24: 468-473
        • Abeysiri S.
        • Chau M.
        • Richards T.
        Perioperative Anemia Management. Seminars in Thrombosis and Hemostasis.
        Thieme Medical Publishers, 2020: 008-016
        • Hua Q.
        • Xu Z.
        • Jiang Y.
        Diagnosis and surgical treatment of carotid body tumor: a retrospective analysis of 58 patients.
        Oncol Lett. 2017; 14: 3628-3632
        • Netterville J.L.
        • Reilly K.M.
        • Robertson D.
        • et al.
        Carotid body tumors: a review of 30 patients with 46 tumors.
        Laryngoscope. 1995; 105: 115-126
        • Cobb A.N.
        • Barkat A.
        • Daungjaiboon W.
        • et al.
        Carotid body tumor resection: just as safe without preoperative embolization.
        Ann Vasc Surg. 2018; 46: 54-59
        • Han T.
        • Wang S.
        • Wei X.
        • et al.
        Outcome of surgical treatment for carotid body tumors in different shambling type without preoperative embolization: a single-center retrospective study.
        Ann Vasc Surg. 2020; 63: 325-331
        • Sevil F.C.
        • Tort M.
        • Kaygin M.A.
        Carotid body tumor resection: long-term outcome of 67 cases without preoperative embolization.
        Ann Vasc Surg. 2020; 67: 200-207
        • Osofsky R.
        • Clark R.
        • Das Gupta J.
        • et al.
        The effect of preoperative embolization on surgical outcomes for carotid body tumor resection.
        SAGE Open Med. 2021; 9 (20503121211005229)