Surgical Treatment of Recurrent Carotid Artery Stenosis and Carotid Artery Stenosis after Neck Irradiation: Evaluation of Operative Risk

Cazaban, S.; Maïza, D; Coffin, Olivier; Radoux, Jean Michel; Mai, Cindy; He, Wen

doi:10.1007/s10016-003-0020-3

Cited by 18 publications

(10 citation statements)

References 14 publications

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“…All injuries were considered to be initial and completely resolved within several weeks, although 1 study reported 9% (1 of 11) permanent CNI. 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).…”

Section: Early Outcomementioning

confidence: 94%

“…22 In the CEA group, 2 articles reported 62.0 Gy and 43.5 Gy as a mean therapeutic dose. 34,35 Range in the mean interval in years between XRT and carotid revascularization was 6.3 to 16.6 years for the CAS group and 1.7 to 17.0 years for the CEA group. More than 50% of patients in the CEA group underwent previous neck surgery in combination with XRT.…”

Section: Radiation Therapymentioning

confidence: 98%

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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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Section: Early Outcomementioning

confidence: 94%

Section: Radiation Therapymentioning

confidence: 98%

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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“…Treatment of this group of patients often requires complex arterial reconstruction because of the extensive amounts of plaque and the difficulty involved in dissecting the plaque from the normal vessel wall. 7 Although carotid endarterectomy and CA reconstructive surgery can be performed safely by experienced practitioners, the frequency of arterial and cranial nerve injuries is higher, and poor wound healing is a potentially disastrous consequence. 3 During the last 10 years, CA angioplasty with or without stent placement has emerged as an excellent treatment alternative for this group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Restenosis reportedly occurs at a rate of 4.8 to 17.6% more than 1 year after CA stent placement for radiation-induced disease. 7,11 Nevertheless, cutting balloon angioplasty, as illustrated in the patient in Case 2, has emerged as an excellent treatment strategy for in-stent stenosis. 4,5 Repeated performance of standard balloon angioplasty with or without secondary stent placement remains another viable alternative.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of carotid artery disease after radiation therapy and radical neck dissection

Ecker¹,

Donovan²,

Hopkins³

2005

FOC

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Object More patients with head and neck cancers who undergo radical neck dissection and adjuvant radiation are experiencing prolonged survival times. Because of their improved survival, patients are living long enough to suffer the delayed effects of radiation therapy. Radiation-induced carotid artery (CA) stenosis in patients with or without radical neck dissection often requires extensive exposure and vessel reconstruction. The aim of this study was to evaluate the efficacy of endovascular treatment as an alternative therapy for radiation-induced CA stenosis. Methods Coinciding with the improved longevity of these patients, CA angioplasty and stent placement has become a definitive treatment strategy for this particularly challenging group of individuals. Long lesions are easily addressed with multiple telescoped stents. The tendency toward early restenosis can now be addressed with cutting balloon angioplasty. A review of the authors' institutional database yielded five patients (four men and one woman) with a history of radiation treatment ipsilateral to their CA stenosis. Three of five patients were symptomatic, and the interval between radiation therapy and endovascular treatment ranged from 1 to 47 years (mean 16.6 years). Four of the five patients were treated using distal embolic protection devices, and all patients underwent balloon dilation after stent placement. Conclusions As advancements are made in the technology and techniques for CA angioplasty and stent placement, the safety and durability of treatments in patients with radiation-induced atherosclerotic disease will improve.

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“…In particular, patients with altered and unfavorable cervical anatomy due to previous carotid or oncologic surgery, cervical irradiation, abnormally high carotid bifurcation, and very short and inextensible neck, may pose significant technical challenges in terms of operating technique increasing the number of complications. 19 Several retrospective studies from surgical series have investigated the problem, 11,[19][20][21][22][23][24][25][26][27][28][29][30] but only considered the main early outcomes of postoperative mortality and major neurologic morbidity. Other periprocedural variables, minor complications, and late results, such as survival, late neurologic events, and restenoses disclosing perhaps directly or indirectly a higher procedural difficulty, have never been properly quantified, nor have safer and long lasting results been proved for patients with a hostile neck treated with CAS or medical therapy.…”

mentioning

confidence: 99%

The hostile neck does not increase the risk of carotid endarterectomy

Frego

Bridda

Ruffolo

et al. 2009

Journal of Vascular Surgery

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Hostile necks led to more complex CEA procedures but without substantial consequences in early and late morbidity and mortality. Most patients with hostile neck can undergo CEA at low risk, with the benefit of effective long-lasting stroke prevention similar to standard patients. In our opinion, the more frequent but temporary cranial nerve dysfunctions that occur are not sufficient to consider hostile neck patients noneligible for CEA.

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Surgical Treatment of Recurrent Carotid Artery Stenosis and Carotid Artery Stenosis after Neck Irradiation: Evaluation of Operative Risk

Cited by 18 publications

References 14 publications

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

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

Endovascular management of carotid artery disease after radiation therapy and radical neck dissection

The hostile neck does not increase the risk of carotid endarterectomy

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