Surgery for carotid artery stenosis following neck irradiation

Friedell, Mark L.; Joseph, Brian P.; Cohen, Michael J.; Horowitz, John D.

doi:10.1007/bf02693794

Cited by 37 publications

(22 citation statements)

References 13 publications

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“…36,37 In total 2 patients developed an ipsilateral occlusion. 9,37 Comparison of outcomes for restenosis and/or occlusion showed a significant difference favoring CEA (Pϭ0.003).…”

Section: Restenosismentioning

confidence: 99%

“…35 Six studies reporting on this specific end point did not encounter any nerve problems at all. 9,18,34,38,40,41 Other procedure-specific complications were incidental, including wound infection and bleeding needing reintervention (Table 4). 21,34,36,37 Late Outcome…”

Section: Early Outcomementioning

confidence: 99%

“…8 Previous cervical radiation therapy (XRT) is one assumed anatomic risk factor, resulting in a "hostile" neck supposedly leading to technically more challenging surgery. 9 Reported causative factors include absent tissue planes in the diseased vessel wall and poor tissue healing through radiation-induced fibrosis. Whether these arguments are sufficiently valid to consider a previously radiated patient as a high-risk patient for surgery is questionable.…”

mentioning

confidence: 99%

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

Fokkema

Hartog

Bots

et al. 2012

Stroke

123

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Background and Purpose-Patients with both carotid stenosis and previously cervical radiation therapy are considered "high risk" for carotid endarterectomy (CEA). Carotid angioplasty and stenting (CAS) seems a reasonable alternative, but neither the operative risk for CEA nor the effectiveness of CAS has been proven. The purpose of this study was to evaluate perioperative and long-term outcome of both procedures in patients with radiation therapy. Methods-A systematic search strategy with the synonyms "carotid artery stenosis" and "cervical irradiation" was conducted in MEDLINE and EMBASE databases. To provide and compare estimates of outcomes, pooled and metaregression analyses were performed. Results-Twenty-seven articles comprising 533 patients undergoing radiation therapy (361 CAS and 172 CEA) fulfilled our inclusion criteria. Pooled analysis showed perioperative risk for "any cerebrovascular adverse event" (CVE) of 3.9% (95% CI, 2.3%-6.7%) in CAS studies against 3.5% (95% CI, 1.5%-8.0%) in CEA studies (Pϭ0.77). Risk for cranial nerve injury (CNI) after CEA was 9.2% (95% CI, 3.7%-21.1%) versus none after CAS. Late outcome showed rates of CVE favoring CEA (Pϭ0.014). The rate of restenosis Ͼ50% was significantly higher in patients treated with CAS compared with CEA (PϽ0.003). Conclusions-Both CAS and CEA proved to be feasible revascularization techniques with low risk for CVE. Although patients undergoing CEA had more temporary CNI, higher rates of late CVE and restenosis were identified after CAS.

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“…36,37 In total 2 patients developed an ipsilateral occlusion. 9,37 Comparison of outcomes for restenosis and/or occlusion showed a significant difference favoring CEA (Pϭ0.003).…”

Section: Restenosismentioning

confidence: 99%

Section: Early Outcomementioning

confidence: 99%

mentioning

confidence: 99%

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

Fokkema

Hartog

Bots

et al. 2012

Stroke

123

View full text Add to dashboard Cite

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“…Most studies are retrospective surgical case series on patients with extracranial carotid stenosis and favor either stenting [67][68][69][70][71] or endarterectomy. 14,[72][73][74][75] Neither approach is clearly superior, as no prospective head-to-head trial exists. A 3-year prospective study has suggested that postangioplasty restenosis rates are significantly higher than proposed.…”

Section: Managementmentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

229

180

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Background and Purpose-Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. Methods-We examined studies on the epidemiology, imaging, pathogenesis, and management of medium-and large-artery intra-and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. Results-The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy.Chronic radiation vasculopathy affecting medium and large intra-and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Conclusions-Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke.Evidence-based guidelines for the management of asymptomatic and symptomatic (medium-and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival. (Stroke. 2011;42:2410-2418.)

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“…In lieu of performing standard carotid endarterectomy (CEA), which may increase the risk of operative complications, carotid artery stenting (CAS) has been suggested in these patients as a minimally invasive alternative. [6] The purpose of this retrospective study was to investigate the effect of neck XRT on the long-term outcome of patients undergoing CAS.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%