Carotid stenting for radiation-induced extracranial carotid artery occlusive disease: efficacy and midterm outcomes.
OBJECTIVE
To investigate the immediate and midterm results of carotid stenting for severe radiation-induced extracranial carotid artery disease.


METHODS
Between April 1998 and May 2002, 16 patients (15 men; mean age 64 +/- 8 years, range 48-72) presented with 18 severe radiation-induced carotid stenoses in the internal carotid artery (n=3), common carotid artery (n=7), and both vessels (n=8). Thirteen (76%) patients were symptomatic; the mean degree of carotid stenosis was 85% +/- 10% (range 70%-95%). An independent neurological specialist assessed perioperative neurological complications before and after treatment. The patients were followed prospectively for at least 12 months by clinical examination and serial duplex ultrasound scanning. Restenosis was defined as a diameter reduction >50%.


RESULTS
Of 18 stent procedures attempted (2 staged), 1 was abandoned owing to failure to pass the guidewire across a tight lesion (94% technical success by intent to treat). In the 17 successfully completed procedures, 17 Wallstents and 4 SMART stents were deployed with satisfactory anatomical results. One postoperative stroke occurred as a result of thromboembolism to the ipsilateral middle cerebral artery and led to hospital death (5.9% combined stroke and death rate). One transient ischemic attack occurred (11.6% neurological event rate). With a median 30-month follow-up (range 5-55), 3 (17.6%) recurrent stenoses (>50%) were detected on duplex scan; 1 repeat angioplasty was performed. No new neurological event has been detected.


CONCLUSIONS
Carotid stenting may be performed in patients with irradiation-induced carotid stenosis with acceptable risks and midterm durability.
Ting
Albert C W
AC
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Cheng
Stephen W K
SW
Yeung
Kai-ming Au
KM
Cheng
Pui-wai
PW
Lui
Wai-man
WM
Ho
Pei
P
Tso
Wai-kuen
WK
D000368:Aged; D017536:Carotid Artery, Common; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy; D015641:Radiography, Interventional; D011878:Radiotherapy / Q000009:adverse effects; D018084:Ultrasonography, Interventional