title: Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis.
abstract: OBJECTIVE
  To evaluate the outcomes of carotid artery stenting (CAS) and open surgical repair (OR) for treatment of radiation-induced carotid stenosis (RICS).
  
  
  METHODS
  We retrospectively reviewed 60 patients treated for 73 RICSs from a group of 5,824 patients who had carotid interventions between 1992 and 2009. Thirty-three patients (37 arteries) were treated with CAS and 27 patients (36 arteries) with OR. CAS was performed using embolic protection as part of a prospective institutional registry since 2003. End-points included mortality, stroke, myocardial infarction (MI), cranial nerve injury (CNI), wound complication, restenosis, and reintervention.
  
  
  RESULTS
  Demographics and cardiovascular risk factors were similar in both groups, with the exception of higher rates (P < .05) of hyperlipidemia (81% vs 56%) and coronary artery disease (63% vs 33%) in OR patients. There were more patients with tracheostomy (31% vs 4%) and time interval from irradiation to intervention was longer in the CAS group. There were no early deaths. At 30 days, OR was associated with one (3%) stroke, two (5.5%) MIs, six (17%) CNIs, and three (8%) wound complications. OR patients with prior radical neck dissections had more wound complications (14% vs 5%) and CNIs (28% vs 9%) compared with those without neck dissections. In the CAS group, there were two (6%) strokes and no MIs, CNIs, or wound complications. Mean length of hospital stay was longer after OR than CAS (4.1 ± 3.7 days vs 2.4 ± 2.1 days; P = .02). Median follow-up was 58 months. At 7 years, OR was associated with higher patient survival (75% ± 15% vs 29% ± 13%, P = .008) and freedom from neurological events (100% vs 57% ± 9.5%, P = .058), but similar freedom from restenosis (80% ± 10% vs 72% ± 9%) and reinterventions (87% ± 10% vs 86% ± 9%) compared with CAS.
  
  
  CONCLUSIONS
  Carotid artery stenting for radiation-induced stenosis has the advantages of no CNI or wound complications with similar early stroke rate compared with open carotid repair. However, the lower freedom from neurological events may offset the early benefits of carotid stenting in patients who are considered good candidates for open surgery.
authors.affiliation: Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Tallarita
authors.forename: Gustavo S
authors.initials: GS
authors.lastname: Oderich
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.forename: Harry
authors.initials: H
authors.lastname: Cloft
authors.forename: David
authors.initials: D
authors.lastname: Kallmes
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Bower
authors.forename: Audra A
authors.initials: AA
authors.lastname: Duncan
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D020209:Cranial Nerve Injuries / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000209:etiology; D018579:Patient Selection; D011832:Radiation Injuries / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome