title: Carotid artery revascularisation following neck irradiation: immediate and long-term results.
abstract: OBJECTIVE
  Carotid artery stenosis is a complication of neck irradiation. We describe the immediate and long-term results of surgical treatment.
  
  
  METHODS
  This was a retrospective single centre study. From 1996 to 2009, 24 consecutive patients who had in the past received neck radiation therapy (mean 12 years, 1-41 years) underwent 27 primary carotid artery revascularisation procedures. Six patients (23%) had previous radical neck dissection, three permanent tracheostomies and one cervicoplasty with pectoral muscle flap. Indications for surgery included symptomatic (five transient ischaemic attacks (TIAs), four strokes; 34%) and asymptomatic (18 patients, 66%) stenosis. Four patients had occlusion of the contralateral carotid. General anaesthesia without shunting was used with measurement of stump pressure. Carotid interposition bypass grafting included 23 vein grafts and three polytetrafluoroethylene (PTFE) grafts.
  
  
  RESULTS
  No perioperative deaths or central neurological events occurred. Three patients suffered transient cranial nerve injuries. Eleven patients died during follow-up, mean interval of 28 months (range 6-120 months), of causes unrelated to surgery. Five patients had recurrent bypass stenosis with one TIA and one stroke. All other surviving patients remained asymptomatic.
  
  
  CONCLUSIONS
  Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures.
authors: Departement of Vascular and Thoracic Surgery, Grenoble University Hospital, Grenoble, France. JLMagne@chu-grenoble.fr
authors: J L
authors: JL
authors: Magne
authors: A
authors: A
authors: Pirvu
authors: C
authors: C
authors: Sessa
authors: E
authors: E
authors: Cochet
authors: H
authors: H
authors: Blaise
authors: C
authors: C
authors: Ducos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002339:Carotid Arteries / Q000528:radiation effects* / Q000601:surgery*; D016893:Carotid Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects / Q000401:mortality; D014680:Veins / Q000637:transplantation*
chemical_list: D011138:Polytetrafluoroethylene