Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis

Shin, Susanna; Stout, Chris E.; Richardson, Albert I.; DeMasi, Richard J.; Shah, Rasesh; Panneton, Jean M.

doi:10.1016/j.jvs.2009.04.066

Cited by 35 publications

(18 citation statements)

References 24 publications

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“…The 2-year restenosis rate was 42%. Another study compared carotid artery stenting results in medically and anatomically high risk patients [13]. The study group included a total of 18 patients with radiation-associated carotid stenosis and a restenosis rate of 22.2% at the end of the study.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of carotid stenting in patients with previous neck radiation

Cam¹,

Shishehbor

Bajaj³

et al. 2013

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Outcomes of carotid stenting in patients with previous neck radiation

Cam¹,

Shishehbor

Bajaj³

et al. 2013

Cathet Cardio Intervent

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“…76 Freedom from restenosis was only 20% (23 XRT patients) versus 79% (127 "high-risk" non-XRT patients). Shin et al 77 also showed that carotid angioplasty and stenting carry a higher restenosis rate in patients with radiation vasculopathy (4 of 18 patients, 22%) versus patients deemed at high risk for carotid endarterectomy for other reasons (most had a previous ipsilateral carotid endarterectomy; 3 of 78 patients, 3.8%, Pϭ0.028). The 2-year restenosis-free survival was also lower in the post-HNXRT group (72.7% versus 95.9%, Pϭ0.017).…”

Section: Managementmentioning

confidence: 97%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

222

176

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Background and Purpose-Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. Methods-We examined studies on the epidemiology, imaging, pathogenesis, and management of medium-and large-artery intra-and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. Results-The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy.Chronic radiation vasculopathy affecting medium and large intra-and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Conclusions-Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke.Evidence-based guidelines for the management of asymptomatic and symptomatic (medium-and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival. (Stroke. 2011;42:2410-2418.)

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“…4 Several studies have been performed in these so-called "high risk" patients to evaluate safety and durability of CAS. 1,2,[5][6][7] Despite favorable results on these aspects, generalizability is limited because no stratification was made within this group for the various different subgroups due to small patient populations. 8 Previous cervical radiation therapy (XRT) is one assumed anatomic risk factor, resulting in a "hostile" neck supposedly leading to technically more challenging surgery.…”

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confidence: 99%

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

Fokkema

Hartog

Bots

et al. 2012

Stroke

118

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Background and Purpose-Patients with both carotid stenosis and previously cervical radiation therapy are considered "high risk" for carotid endarterectomy (CEA). Carotid angioplasty and stenting (CAS) seems a reasonable alternative, but neither the operative risk for CEA nor the effectiveness of CAS has been proven. The purpose of this study was to evaluate perioperative and long-term outcome of both procedures in patients with radiation therapy. Methods-A systematic search strategy with the synonyms "carotid artery stenosis" and "cervical irradiation" was conducted in MEDLINE and EMBASE databases. To provide and compare estimates of outcomes, pooled and metaregression analyses were performed. Results-Twenty-seven articles comprising 533 patients undergoing radiation therapy (361 CAS and 172 CEA) fulfilled our inclusion criteria. Pooled analysis showed perioperative risk for "any cerebrovascular adverse event" (CVE) of 3.9% (95% CI, 2.3%-6.7%) in CAS studies against 3.5% (95% CI, 1.5%-8.0%) in CEA studies (Pϭ0.77). Risk for cranial nerve injury (CNI) after CEA was 9.2% (95% CI, 3.7%-21.1%) versus none after CAS. Late outcome showed rates of CVE favoring CEA (Pϭ0.014). The rate of restenosis Ͼ50% was significantly higher in patients treated with CAS compared with CEA (PϽ0.003). Conclusions-Both CAS and CEA proved to be feasible revascularization techniques with low risk for CVE. Although patients undergoing CEA had more temporary CNI, higher rates of late CVE and restenosis were identified after CAS.

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Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis

Cited by 35 publications

References 24 publications

Outcomes of carotid stenting in patients with previous neck radiation

Outcomes of carotid stenting in patients with previous neck radiation

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Stenting Versus Surgery in Patients With Carotid Stenosis After Previous Cervical Radiation Therapy

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