Evaluation of carotid angioplasty and stenting for radiation-induced carotid stenosis.
OBJECTIVE
We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control.


METHODS
In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR.


RESULTS
The median follow-up was 47.3 months (95% confidence interval, 26.9-61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031).


CONCLUSIONS
The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR.


BACKGROUND
This trial was not registered as enrollment started in 2006.
From the Department of Imaging and Interventional Radiology, Prince of Wales Hospital (S.C.H.Y., J.W.Y.H., K.T.L.), Vascular and Interventional Radiology Foundation Clinical Science Center (S.C.H.Y., J.W.Y.H., K.T.L., T.W.L.), and Department of Medicine and Therapeutics, Prince of Wales Hospital (W.X.Y.Z., Y.O.Y.S., L.W., A.Y.Y.C., V.H.L.I., F.S.Y.F., A.L.C.C., L.K.S.W., T.W.L.), The Chinese University of Hong Kong, Hong Kong, China.
Simon C H
SC
Yu
Winnie X Y
WX
Zou
Yannie O Y
YO
Soo
Lily
L
Wang
Joyce Wai Yi
JW
Hui
Anne Y Y
AY
Chan
Kwok Tung
KT
Lee
Vincent H L
VH
Ip
Florence S Y
FS
Fan
Annie L C
AL
Chan
Lawrence K S
LK
Wong
Thomas W
TW
Leung
D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D002340:Carotid Artery Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016893:Carotid Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
carotid stenosis; head and neck neoplasms; outcome and process assessment (health care); radiotherapy