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Updated: Jun 20, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced
Susanna H Shin1, Christopher L Stout, Albert I Richardson
1Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Insights
Carotid angioplasty and stenting (CAS) is safe and effective for both medically and anatomically high-risk patients. However, radiation-induced stenosis increases restenosis risk after CAS.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Carotid angioplasty and stenting (CAS) is an alternative to carotid endarterectomy (CEA) for high-risk patients.
- High-risk patients are defined by medical comorbidities or anatomical factors like prior surgery or radiation.
Purpose of the Study:
- To compare the technical feasibility and durability of CAS in medically high-risk (MED) versus anatomically high-risk (ANAT) patients.
- To evaluate outcomes including technical success, stroke, myocardial infarction, death, and in-stent restenosis.
Main Methods:
- Retrospective review of consecutive CAS procedures performed by a single vascular surgery group.
- All high-risk patients evaluated with duplex ultrasound and angiography.
- Primary endpoints: technical success, 30-day stroke, MI, death, in-stent restenosis; analyzed using Kaplan-Meier life tables.
Main Results:
- 230 CAS procedures performed (98 ANAT, 132 MED). Technical success rates were similar (98% ANAT vs. 98.5% MED).
- 30-day stroke rates (1.0% ANAT vs. 5.3% MED) and mortality rates (2.0% ANAT vs. 0.8% MED) were comparable.
- Two-year survival free from stroke was high in both groups (98.9% ANAT vs. 93.6% MED).
- Restenosis rates were similar overall (91.0% ANAT vs. 91.9% MED), but significantly higher in patients with prior neck radiation (22.2% vs. 3.8% in non-radiated ANAT patients).
Conclusions:
- CAS demonstrates comparable technical feasibility, safety, and durability in anatomically high-risk patients versus medically high-risk patients.
- Patients with radiation-induced stenosis face a significantly increased risk of restenosis after CAS.
- CAS is a viable option for anatomically high-risk patients, with specific attention needed for those with prior radiation history.
Objective:
Carotid angioplasty and stenting (CAS) is used in patients considered high-risk for carotid endarterectomy (CEA). Patients qualify as high-risk because of medical comorbid conditions or for anatomic considerations (previous CEA, radical neck dissection, radiation). We compared the technical feasibility and durability of CAS in medically high-risk patients (MED) vs anatomically high-risk patients (ANAT).
Methods:
A retrospective review was performed of all consecutive patients undergoing CAS by a single vascular surgery group. All patients were high risk and evaluated with duplex ultrasound imaging and angiography. Primary end points were technical success, 30-day stroke, myocardial infarction (MI), death, and in-stent restenosis. Standard statistical analysis included Kaplan-Meier life tables.
Results:
From January 2003 to December 2007, 230 CAS (98 ANAT, 132 MED) procedures were attempted. The ANAT cohort comprised 84 patients with a single anatomic risk factor: 71 with a previous ipsilateral CEA, 6 high lesions, 6 history of neck radiation, and 1 with a tracheostomy. Ten patients had two or three anatomic risk factors: nine with radical neck dissection and radiation and one with neck radiation and ipsilateral CEA. The mean age was 71.1 years for ANAT vs 73.9 years for MED (P = .021). Technical success rates were 98% in ANAT and 98.5% in MED (P = .76). Thirty-day stroke rate was 1.0% in ANAT and 5.3% in MED (P = .14); the mortality rate was 2.0% in ANAT and 0.8% in MED (P = .79). The 2-year survival free from stroke was MED, 93.6% and ANAT, 98.9% (P = .118); and from restenosis was MED, 91.9%; and ANAT, 91.0% (P = .98). Two-year overall survival was significantly better in ANAT (84.6%) vs MED (70.1%; P = .026). Four of the seven restenoses in the ANAT group occurred in patients with previous neck radiation. The restenosis rate for radiation-induced (RAD) stenosis treated with CAS was significantly higher at 22.2% (4 of 18) compared with 3.8% (3 of 78) in ANAT group patients without a history of radiation (non-RAD; P = .028). The 2-year restenosis-free survival was 72.7% in the RAD group vs 95.9% in the non-RAD group (P = .017).
Conclusion:
CAS is as technically feasible, safe, and durable in anatomically high-risk patients as in medically high-risk patients, with similar rates of periprocedural stroke and death and late restenosis. However, patients with radiation-induced stenosis appear to be at an increased risk for restenosis.
