Radiation arteritis: A contraindication to carotid stenting?

Abstract

CAS for radiation arteritis has poor long-term anatomic outcome and can present with late asymptomatic occlusions. These findings suggest that these patients require closer postoperative surveillance and raise the question of whether CAS is appropriate for carotid occlusive lesions caused by radiation arteritis.

Long-term Outcomes of Carotid Artery Stenting for Radiation-Associated Stenosis

“…In addition, there were significantly fewer patients with CAD, hypertension, hyperlipidemia, DM, and chronic kidney disease in our XRT group, and this finding differed from similar studies reported in the Western literature. [9,10] The perioperative complications and primary outcomes, all causes of mortality, ipsilateral recurrent stroke, and MACE, did not significantly differ between the XRT and non-XRT patients, as noted previously. [9,10] However, a significantly higher restenosis rate was observed in our XRT patients, which correlated with previous studies.…”

“…Information regarding such a large number of XRT patients is a unique characteristic of our study when compared to similar studies performed in the West. [9,10] The mean age of our XRT patients was significantly lesser compared to the non-XRT patients. In addition, there were significantly fewer patients with CAD, hypertension, hyperlipidemia, DM, and chronic kidney disease in our XRT group, and this finding differed from similar studies reported in the Western literature.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…The incidence of restenosis after CAS has been in the range of 3% to 5%. [215][216][217][218][219][220][221][222][223][224][225][226][227][228][229][230][231][232][233] The incidence of TIA has been reported as 1% to 2% in patients undergoing CAS. Intracranial hemorrhage and the hyperperfusion syndrome related to hypertension and anticoagulation have been reported as complications in <1% of CAS procedures.…”

When is carotid stenting acceptable as a means of stroke prevention?

“…The overall 3-year rate of freedom from all fatal and non fatal strokes was 96% [15]. Unfortunately, the long-term clinical durability of stenting for this indication is questioned, since severe in-stent restenosis and occlusion has been reported [16,17]. The routine use of EPDs is advocated with CAS.…”