Endovascular management of carotid artery disease after radiation therapy and radical neck dissection

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>More patients with head and neck cancers who undergo radical neck dissection and adjuvant radiation are experiencing prolonged survival times. Because of their improved survival, patients are living long enough to suffer the delayed effects of radiation therapy. Radiation-induced carotid artery (CA) stenosis in patients with or without radical neck dissection often requires extensive exposure and vessel reconstruction. The aim of this study was to evaluate the efficacy of endovascular treatment as an alternative therapy for radiation-induced CA stenosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Coinciding with the improved longevity of these patients, CA angioplasty and stent placement has become a definitive treatment strategy for this particularly challenging group of individuals. Long lesions are easily addressed with multiple telescoped stents. The tendency toward early restenosis can now be addressed with cutting balloon angioplasty. A review of the authors' institutional database yielded five patients (four men and one woman) with a history of radiation treatment ipsilateral to their CA stenosis. Three of five patients were symptomatic, and the interval between radiation therapy and endovascular treatment ranged from 1 to 47 years (mean 16.6 years). Four of the five patients were treated using distal embolic protection devices, and all patients underwent balloon dilation after stent placement.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>As advancements are made in the technology and techniques for CA angioplasty and stent placement, the safety and durability of treatments in patients with radiation-induced atherosclerotic disease will improve.</jats:p></jats:sec>

Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis

“…27 Similar to other reports, we have found that open carotid repair can be performed safely with no early death, and low stroke (4%) and restenosis rates (11%). 4,[6][7][8][9][10][11][12][13][31][32][33] Conversely, carotid stents may not be as durable as open carotid repair in the radiated neck. Protack et al 12 reported restenosis in 43% of 23 patients treated for radiation-induced lesions with carotid stenting, including two (8.5%) who had stent occlusion.…”

“…It avoids the need to dissect through scarred tissue and the potential risks of cranial nerve injury or wound healing complications. 4,[6][7][8][9][10][11][12][13] However, the enthusiasm with CAS has been tempered by high rates of restenosis and reinterventions in the range of 4% to 51% in contemporary reports dealing with radiation-induced carotid stenosis (RICS). 4,[8][9][10]6,12,13 The aim of this study was to review the outcomes of CAS and of a historical group treated with open carotid repair (OR) for RICS.…”

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

“…Simultaneously, the risk for relevant carotid stenosis seems to increase. 42 Several carotid intervention studies defined Ecker et al 27 patients undergoing XRT as a high-risk group for CEA. 2,43,44 This classification remains controversial because the definition was based on theoretical arguments and still no risk stratification for patients undergoing XRT exists today.…”

“…Large differences among studies existed. Two small studies 17,27 (nϭ5 and nϭ7) found no restenosis and no reinterventions performed during follow-up (9.3 and 6.0 months). Two slightly larger studies both monitored 16 patients for, respectively, 30 and 28 months and found restenosis rates of 17.6% and 21.0%.…”

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

“…With the further development of new stent devices, delivery techniques, and cerebral protection devices, the use of CAS for the treatment of radiation-induced carotid stenosis will become safer and more durable [46]. …”