Carotid artery stenting for stenosis following revascularization or cervical irradiation.
OBJECTIVE
To assess the safety and efficacy of carotid artery stenting (CAS) for stenosis following revascularization or cervical irradiation.


METHODS
Twenty-two CAS procedures performed on 21 patients (20 men; mean age 69.3 years, range 58-87) from June 1997 to June 2000 were retrospectively reviewed. There were 5 radiation-induced carotid stenoses in 4 patients and 17 postsurgical restenoses. The mean interval between carotid revascularization and CAS was 48.1 months (range 6-264), while the elapsed time from irradiation to CAS was always >8 years (range 8-28). Seven patients screened during this period were excluded from CAS because of a duplex-defined >50% hypoechoic lesion and/or angiographic documentation of an irregular ulcerated stenosis.


RESULTS
Four Palmaz and 16 Wallstents were successfully deployed in 20 arteries; 1 access failure prompted conversion to surgery and a stent delivery failure resulted in 1 patient receiving balloon dilation only (technical success 91%). No complications were encountered in the periprocedural period, and no neurological events were observed during a mean follow-up of 16.6 months (range 3-36). One patient died at 20 months from an unrelated cause. One (4.8%) restenosis was detected after 1 year in the patient who did not receive a stent.


CONCLUSIONS
CAS is a safe alternative to conventional surgery in patients with carotid artery stenosis following surgical revascularization or cervical irradiation provided preoperative testing excludes stenoses at risk for embolism.
Alric
Pierre
P
Service de Chirurgie Vasculaire et Thoracique, Hĵpital Arnaud de Villeneuve, Montpellier, France. pierrealric@hotmail.com
Branchereau
Pascal
P
Berthet
Jean-Philippe
JP
Mary
Henri
H
Marty-Ané
Charles
C
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods* / Q000401:mortality; D002339:Carotid Arteries / Q000528:radiation effects*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology