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Carotid artery stenting for stenosis following revascularization or cervical irradiation
Pierre Alric1, Pascal Branchereau, Jean-Philippe Berthet
1Service de Chirurgie Vasculaire et Thoracique, Hĵpital Arnaud de Villeneuve, Montpellier, France. pierrealric@hotmail.com
Purpose:
To assess the safety and efficacy of carotid artery stenting (CAS) for stenosis following revascularization or cervical irradiation.
Methods:
Twenty-two CAS procedures performed on 21 patients (20 men; mean age 69.3 years, range 58-87) from June 1997 to June 2000 were retrospectively reviewed. There were 5 radiation-induced carotid stenoses in 4 patients and 17 postsurgical restenoses. The mean interval between carotid revascularization and CAS was 48.1 months (range 6-264), while the elapsed time from irradiation to CAS was always >8 years (range 8-28). Seven patients screened during this period were excluded from CAS because of a duplex-defined >50% hypoechoic lesion and/or angiographic documentation of an irregular ulcerated stenosis.
Results:
Four Palmaz and 16 Wallstents were successfully deployed in 20 arteries; 1 access failure prompted conversion to surgery and a stent delivery failure resulted in 1 patient receiving balloon dilation only (technical success 91%). No complications were encountered in the periprocedural period, and no neurological events were observed during a mean follow-up of 16.6 months (range 3-36). One patient died at 20 months from an unrelated cause. One (4.8%) restenosis was detected after 1 year in the patient who did not receive a stent.
Conclusions:
CAS is a safe alternative to conventional surgery in patients with carotid artery stenosis following surgical revascularization or cervical irradiation provided preoperative testing excludes stenoses at risk for embolism.