Surgical treatment of recurrent carotid artery stenosis and carotid artery stenosis after neck irradiation: evaluation of operative risk.
Surgical treatment of recurrent carotid artery stenosis after endarterectomy and carotid artery stenosis after neck irradiation purportedly has a higher complication rate than primary carotid endarterectomy (CEA). Accordingly, carotid angioplasty has been proposed as a safer alternative. The purpose of this study was to evaluate operative risks on the basis of our experience with these lesions. A series of 679 carotid revascularizations (CRV) performed over a period of 9 years was retrospectively reviewed. Immediate outcome and operative technique was analyzed in three groups: group 1 included 549 "routine" CRV, group 2 included 8 CRV for recurrent stenosis after CEA, and group 3 consisted of 11 CRV for stenosis after neck irradiation. No difference in revascularization techniques was found between groups 1 and 2. In contrast there were fewer CEA and resection-anastomosis procedures in group 2 than in group 1 (62.5% vs. 98.2%; p < 0.0006) and more bypass procedures (37.5% vs. 1.8%; p = 0.0015). The cumulative neurological morbidity/mortality rate (CMMR) was 0% in groups 2 and 3 as compared to 4.4% in group 1. In comparison with group 1, early and permanent neurological morbidity rates were significantly higher in both group 2 (2.2% vs. 25.0%; p = 0.015 and 0.2% vs. 12.5%; p = 0.028, respectively) and group 3 (2.2% vs. 18.2%; p = 0.028 and 0.2% vs. 9.1%; p = 0.039, respectively). Surgical treatment of recurrent stenosis after CEA and stenosis after neck irradiation is not associated with a higher CMMR. The only potentially valid justification for using percutaneous transluminal angioplasty in these patients would be a higher risk of cervical neurological morbidity.
Cazaban
S
S
Service de Chirurgie Thoracique et Cardio-vasculaire, CHU Côte de Nacre, Caen, France.
Maïza
D
D
Coffin
O
O
Radoux
J M
JM
Mai
C
C
Wen
H Y
HY
D000368:Aged; D016893:Carotid Stenosis / Q000209:etiology / Q000601:surgery*; D016022:Case-Control Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D008297:Male; D009017:Morbidity; D009333:Neck / Q000528:radiation effects; D011183:Postoperative Complications / Q000453:epidemiology*; D011878:Radiotherapy / Q000009:adverse effects*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors