Outcome of carotid artery stenting for radiation-induced stenosis.
OBJECTIVE
Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients.


METHODS
We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location.


RESULTS
Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis.


CONCLUSIONS
The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.
Dorresteijn
Lucille D A
LD
Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands. L.Dorresteijn@mst.nl
Vogels
Oscar J M
OJ
de Leeuw
Frank-Erik
FE
Vos
Jan-Albert
JA
Christiaans
Marleen H
MH
Ackerstaff
Rob G A
RG
Kappelle
Arnoud C
AC
D000368:Aged; D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology*; D008297:Male; D011446:Prospective Studies; D011832:Radiation Injuries / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology*