Outcomes of carotid angioplasty and stenting for radiation-associated stenosis.
OBJECTIVE
In light of their high surgical risk, carotid angioplasty and stent placement may be preferred in patients with radiation-associated carotid stenosis. The purpose of this study was to determine the procedural complication rate, patency, and clinical outcomes after carotid angioplasty and stent placement in this small group of high-risk patients.


METHODS
Sixteen patients (mean age, 65 years; 5 women and 11 men) who received radiation therapy for head and/or neck malignancy subsequently developed carotid stenosis (mean, 84%; range, 70%-99%) in a total of 19 carotid arteries, which were treated with angioplasty and stent placement. The patients were followed for a mean time of 28 months (range, 5-78 months) with periodic Doppler studies, angiography, CT angiography, or clinically.


RESULTS
In the total 19 stented carotid arteries, 23 procedures were performed (22 stent placement procedures and one repeat angioplasty). The procedural stroke rate was 1/23 (4%). The procedural transient ischemic attack rate was 0/23 (0%). There was one other observed complication: a puncture site hematoma. The 30-day postprocedure complication rate was 0/23 (0%); no neurologic symptoms were reported. Fifteen of the 19 vessels (79%) developed no new stenosis throughout the follow-up period. Two of 19 (11%) vessels had repeat angioplasty and stent placement; 1/19 (5%) had a repeat angioplasty. One restented vessel has remained patent for 50 months. Another restented vessel required a third stent placement 17 months after the second. Two of 19 (11%) vessels occluded per Doppler examination 14 and 22 months postprocedure.


CONCLUSIONS
Angioplasty and stent placement have low rates of complications and restenosis in the treatment of radiation-associated carotid occlusive disease.
Harrod-Kim
Paul
P
Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA.
Kadkhodayan
Yasha
Y
Derdeyn
Colin P
CP
Cross
DeWitte T
DT
Moran
Christopher J
CJ
D000368:Aged; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000009:adverse effects; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications*; D019233:Retreatment; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency