Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis

• Published in: International journal of radiation oncology, biology, physics Vol. 77; no. 5; pp. 1386 - 1390
• Main Authors: Dorresteijn, Lucille D.A., M.D., Ph.D, Vogels, Oscar J.M., M.D., Ph.D, de Leeuw, Frank-Erik, M.D., Ph.D, Vos, Jan-Albert, M.D., Ph.D, Christiaans, Marleen H., M.D, Ackerstaff, Rob G.A., M.D., Ph.D, Kappelle, Arnoud C., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2010; Elsevier
• Subjects: Aged; Angioplasty, Balloon; ARTERIES; Biological and medical sciences; Blood and lymphatic vessels; BLOOD VESSELS; BODY; Cardiology. Vascular system; CARDIOVASCULAR SYSTEM; Carotid angioplasty and stenting; CAROTID ARTERIES; Carotid artery; Carotid artery stenosis; Carotid Stenosis - mortality; Carotid Stenosis - therapy; DISEASES; Diseases of the cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; HEAD; Head and neck cancer; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; Ischemic Attack, Transient - etiology; Male; Medical sciences; MEDICINE; NECK; NEOPLASMS; Neurology; NUCLEAR MEDICINE; ORGANS; Prospective Studies; Radiation Injuries - mortality; Radiation Injuries - therapy; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Stents - adverse effects; Stroke; Stroke - etiology; THERAPY; TUBES; Vascular diseases and vascular malformations of the nervous system; Head and neck cancer; Stroke; Radiotherapy; Carotid artery stenosis; Carotid angioplasty and stenting; Carotid stenosis; Nervous system diseases; Prognosis; Angioplasty; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Malignant tumor; Stent; Cerebral disorder; Artery stenosis; Arterial disease; Vascular disease; Carotid; Central nervous system disease; ENT disease; Cerebrovascular disease; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.06.045

Purpose Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients. Methods and Materials We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location. Results Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3–11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis. Conclusions The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.