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Radiation arteritis: a contraindication to carotid stenting?
Clinton D Protack1, Andrew M Bakken, Wael E Saad
1Center for Vascular Disease, Department of Surgery, University of Rochester, Rochester, NY 14642, USA.
Journal of Vascular Surgery
|January 11, 2007
Summary
Carotid artery stenting (CAS) for radiation arteritis shows poor long-term results, with a higher rate of restenosis and late occlusions. Patients require closer surveillance, questioning the procedure's suitability for radiation-induced carotid disease.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Radiology
Background:
- Carotid artery stenting (CAS) is standard for high-risk lesions.
- Radiation arteritis is a common indication for CAS.
- Outcomes of CAS for radiation arteritis are not well-defined.
Purpose of the Study:
- To evaluate the clinical outcomes of CAS in patients with radiation arteritis.
- To compare outcomes between atherosclerotic occlusive disease (ASOD) and radiotherapy (XRT)-induced occlusive disease.
- To identify factors associated with adverse outcomes after CAS.
Main Methods:
- Prospective database analysis of CAS patients from 1999-2006.
- Comparison of primary CAS for ASOD versus XRT-induced disease.
- Life-table analysis and Cox proportional hazard analysis for outcomes.
Main Results:
- No significant difference in 30-day mortality or 3-year overall survival between ASOD and XRT groups.
- Similar major adverse event rates and 3-year neurologic event-free rates.
- Significantly worse 3-year freedom from restenosis (20% vs 74%) and patency (91% vs 100%) in the XRT group.
Conclusions:
- CAS for radiation arteritis has poor long-term anatomic outcomes.
- Late asymptomatic occlusions are unique to the XRT group.
- Increased surveillance and reconsideration of CAS for radiation arteritis are recommended.
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