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Carotid Artery Stenting May Be Performed Safely in Patients With Radiation Therapy-Associated Carotid Stenosis Without Increased Restenosis or Target Lesion Revascularization: Results of a Multicenter Review

2014; Elsevier BV; Volume: 59; Issue: 2 Linguagem: Inglês

10.1016/j.jvs.2013.11.028

1097-6809

Reid A. Ravin, Armand Gottlieb, Kyle Pasternac, William E. Beckerman, Daniel I. Fremed, Rami O. Tadros, Neal S. Cayne, Darren B. Schneider, Prakash Krishnan, Michael L. Marin, Peter L. Faries,

Oropharyngeal Anatomy and Pathologies

Neck radiation therapy (XRT) may induce carotid artery atherosclerosis and may increase the technical difficulty of endarterectomy (CEA). It is considered a relative indication for carotid angioplasty and stenting (CAS). This study sought to evaluate differences in CAS embolic potential and restenosis performed on XRT and non-XRT patients. A total of 366 CAS procedures were performed on 321 patients (43 XRT and 323 non-XRT) at three institutions. Mean follow-up was 410 days (median, 282 days; range, 3-1920 days). Patients were followed up with duplex ultrasound imaging to assess for restenosis. Additional end points included target lesion revascularization, myocardial and cerebrovascular events, and perioperative complications. Captured particulates from embolic protection filters were analyzed using photomicroscopy and image analysis software for 27 XRT and 214 non-XRT filters. XRT patient were more likely to be male and had lower rates of hypertension, coronary artery disease, and diabetes mellitus, although the mean age at procedure did not differ (Table). There was a trend toward increased severe internal carotid tortuosity among XRT patients (XRT: 50% vs non-XRT: 34.7%; P = .05). Indication for CAS did not differ between the two groups, including the number of CAS performed for symptomatic carotid stenosis (XRT: 39.7% vs non-XRT: 39.0%; P = not significant [NS]). Perioperative outcomes, including the composite of 30-day stroke/myocardial infarction/mortality were not significantly different (XRT: 2.6% vs non-XRT: 3.9%; P = NS.) There were no significant differences in the restenosis rate at the 50% (XRT: 9.4% vs non-XRT: 8.6%; P = NS) or 70% (XRT: 3.5% vs non-XRT: 8.6%; P = NS) threshold. Filter particle analysis revealed that filters from XRT patients had more numerous large particles per filter and larger particles (Table). Target lesion revascularization did not differ significantly between the groups. In contrast to earlier studies, this analysis reveals that there are significant differences in XRT and non-XRT patients undergoing CAS in terms of medical comorbidities, anatomy, and embolic potential. A decreased incidence of atherosclerotic risk factors was observed in XRT patients, likely because XRT was the primary factor responsible for carotid stenosis. Despite increased tortuosity and embolic particle size, CAS can be performed safely with no increased morbidity, target lesion revascularization, or restenosis in XRT patients.TableDemographics and particulate data (P values by χ2 and t-test)VariableXRTNon-XRTPMean age, years68.971.1NSMale, No. (%)34 (79)183 (56.7)<.01Hypertension, No. (%)26 (63.4)292 (90.6)<.0001Coronary artery disease, No. (%)15 (36.5)192 (59.6)<.05Diabetes mellitus, No. (%)8 (19.5)117 (36.3)<.05Particulate data Mean maximum particle size/filter, μm1.40.74<.05 Mean maximum particle size/filter, μm1504.5307.8<.01 Open table in a new tab