Carotid Stenting for Severe Radiation-Induced Extracranial Carotid Artery Occlusive Disease

Al-Mubarak, Nadim; Roubin, Gary S.; Iyer, Sriram S.; Gomez, Camilo R.; Liu, Ming W.; Vitek, Jiri J.

doi:10.1177/152660280000700106

Cited by 55 publications

(24 citation statements)

References 17 publications

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“…Four additional studies were retrieved from crossreferencing. [17][18][19][20] No additional studies were identified from books or abstract of major meetings. As a result, a total of 27 publications were included, comprising 533 patients divided in the CAS group (14 articles 17,19 -31 ; 361 patients, symptomatic: median 59% [Quartiles 1-3ϭ51%-75%]) and CEA group (14 articles 4,9,18,21,32-41 ; 172 patients, symptomatic: median 67% [Quartiles 1-3ϭ46%-86%]).…”

Section: Resultsmentioning

confidence: 99%

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

Fokkema

Hartog

Bots

et al. 2012

Stroke

121

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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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Section: Resultsmentioning

confidence: 99%

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

Fokkema

Hartog

Bots

et al. 2012

Stroke

121

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“…The effect of antiplatelet, anticoagulant, antihypertensive, or lipid-lowering therapy in limiting disease progression is therefore unclear. Most studies are retrospective surgical case series on patients with extracranial carotid stenosis and favor either stenting [67][68][69][70][71] or endarterectomy. 14,[72][73][74][75] Neither approach is clearly superior, as no prospective head-to-head trial exists.…”

Section: Managementmentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

227

180

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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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“…В дополнение к сосудистым заболеваниям, РТ влияет на микрососудистое русло, что ведет к уменьшению коронарного резерва, ишемии мио-карда и фиброзу. Повышен риск развития сте-нозов сонных артерий и ишемического инсульта после лучевой терапии назо-фарингеальных опухолей [57][58][59][60][61][62]. Схожее по механизму пораже-ние периферических артерий от РТ отмечается у пациентов, получающих лечение по-поводу различных злокачественных опухолей брюшной полости и малого таза, хотя такие осложнения и последствия РТ встречаются реже, чем ослож-нения в виде ИБС.…”

Section: радиационная терапия и сердечно-сосудистые заболеванияunclassified

Cardiooncology: Chemotherapy Drugs and Radiation Therapy Impact on Cardiovascular System

Doundoua¹,

Стаферов²,

Sorokin³

et al. 2016

Journal of Clinical Practice

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Противораковая терапия может стать причиной стенокардии, острого коронарного синдрома, мозгового инсульта, критической ишемии конечностей, аритмий и сердечной недостаточности. Новая специализация в кардиологии, называемая кардиоонкологией, изучает осложнения со стороны сердечно-сосудистой системы, возникающие на фоне лечения онкологического заболе-вания. Первая часть литературного обзора, основанного на публикациях последних десятилетий, посвящена определению кардионкологии, механизмам развития кардиотоксичности и сосудис-той токсичности при применении ряда противоопухолевых препаратов, негативно влияющих на сердечно-сосудистую систему.Ключевые слова: кардиоонкология, онкокардиология, кардиотоксичность, химиотерапия, радиационное поражение сердца. CArdioonCology: ChemotherApy drugs And rAdiAtion therApy impACton CArdiovAsCulAr system D.P. Doundoua, А.V. Staferov, А.V. Sorokin, А.G. Kedrova.Anticancer therapy can cause angina pectoris, acute coronary syndrome, stroke, critical limb ischemia, arterial hypertension, arrhythmias and heart failure. The new specialization in cardiology, called cardiooncology, exploring the complications of cardiovascular system, arising during the treatment of cancer. The first part of the review, based on the publications of the last decades, is dedicated to the definition of cardiooncology, mechanisms of cardiac and vascular toxicity with a number of anticancer drugs affecting the cardiovascular system.

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Carotid Stenting for Severe Radiation-Induced Extracranial Carotid Artery Occlusive Disease

Abstract: Carotid stenting is an effective treatment option for severe radiation-induced carotid artery occlusive disease.

Cited by 55 publications

References 17 publications

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

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

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Cardiooncology: Chemotherapy Drugs and Radiation Therapy Impact on Cardiovascular System

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