Carotid artery revascularization through a radiated field

Area of Science:

• Vascular Surgery
• Neurosurgery
• Oncology

Background:

• Extracranial carotid stenosis can be a complication following external head and neck irradiation.
• The safety and long-term efficacy of carotid artery revascularization in radiated fields remain debated.
• This study evaluates outcomes in patients with previous radiation therapy undergoing carotid revascularization.

Purpose of the Study:

• To assess the immediate and long-term safety and durability of carotid artery revascularization in patients with prior radiation therapy.
• To evaluate the incidence of perioperative complications, stroke, and recurrent stenosis.

Main Methods:

• A series of 27 consecutive patients (30 procedures) with prior radiation (mean 10 years post-radiation, mean dose 62 Gy) underwent carotid revascularization.
• Procedures included carotid endarterectomy (n=20), interposition bypass (n=7), and subclavian to carotid bypass (n=3).
• Patients were followed for a mean of 40 months, with assessment of clinical outcomes and duplex scans.

Main Results:

• One perioperative death (3.3%) and one transient ischemic attack occurred. In-hospital complications included neck hematoma in 2 patients.
• No delayed wound healing or infection was observed. Surviving patients remained stroke-free during follow-up.
• Recurrent stenosis (>60%) occurred in 16.6% of patients at 18 months, with 3 patients requiring reoperation.

Conclusions:

• Carotid revascularization through a radiated field is a safe and durable procedure for high-risk patients, providing sustained freedom from stroke.
• Despite a notable incidence of recurrent stenosis, the benefits of revascularization outweigh the risks in selected patients.
• The procedure offers a viable option for managing carotid stenosis in patients with a history of head and neck radiation.