Endovascular treatment for carotid artery stenosis after neck irradiation

Abstract

The immediate outcome of CAS for irradiation-induced carotid artery stenosis was satisfactory. Medium-term neurologic outcome was acceptable, but the incidence of anatomic events such as thrombosis and restenosis was high. A randomized study is needed to confirm that the outcome of the endovascular and surgical therapy is comparable in this indication.

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

“…26 In total, 5 TIAs were identified: 1 contralateral and 1 ipsilateral of the CAS site, 22 1 related to restenosis, and 2 due to carotid thrombosis. 24 In the CEA group (9 studies, 121 patients), 1 event (TIA) 36 over a total of 386.7 person-years of follow-up was reported, on average 2.8 per 100 person-years (95% CI, 2.0 -3.9). The difference in the CVE rate between both procedures was significant (Pϭ0.014).…”

“…20 Technical success rate was reported varying from 94% to 100%. Six failures occurred: 3 needed conversion to surgery, 24 1 stent became lodged in the curve of the introducer sheet (only balloon dilatation was performed), 31 1 was abandoned owing to failure to pass the guidewire across a tight lesion, 20 and 1 patient had residual stenosis after the procedure. 26 In the CEA group (14 studies with 172 patients, 190 procedures), pooled analysis showed a risk of 3.5% (95% CI, 1.5%-8.0%; I 2 ϭ0%) for CVE.…”

“…22 Three other strokes were related to restenosis and occurred in a series of 135 patients at a mean interval of 16 months. 24 Another 3 ipsilateral strokes (2 major, 1 minor; not further defined) were identified in a series of 30 patients after a mean follow-up of 58 months, in which 1 patient had carotid stent occlusion after 38 months. 21 No further information was provided on 2 strokes observed in the study by Protack et al (23 patients; mean follow-up, 14.4 months).…”

“…This rate seemed to be highly influenced by nonvascular causes of death such as pre-existent cancer in both groups. 21,22,24,34,36 …”

Long-term Outcomes of Carotid Artery Stenting for Radiation-Associated Stenosis

“…[12] We believe this is the underlying reason for the significantly younger age of the XRT patients in our study compared with the other studies in the West. [9,10,13] In patients who have undergone neck XRT for malignancy, chronic radiation vasculopathy affects both intra-and extracranial arteries, with increasing rates of stenosis over time. [14] The relative risk of TIA or ischemic stroke is at least doubled, [15] and the interval between the completion of XRT and the stroke event is more than 10 years.…”