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Title: Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis

Abstract

Purpose: Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients. Methods and Materials: We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location. Results: Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis. Conclusions:more » The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.« less

Authors:
 [1];  [2];  [1];  [3];  [4];  [2];  [1]
  1. Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen (Netherlands)
  2. Department of Neurology and Clinical Neurophysiology, St Antonius Hospital, Nieuwegein (Netherlands)
  3. Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands)
  4. Department of Neurology, Diakonessenhuis, Utrecht (Netherlands)
Publication Date:
OSTI Identifier:
21436110
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 77; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2009.06.045; PII: S0360-3016(09)01008-6; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CAROTID ARTERIES; HEAD; NECK; NEOPLASMS; RADIOTHERAPY; TUBES; ARTERIES; BLOOD VESSELS; BODY; CARDIOVASCULAR SYSTEM; DISEASES; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY

Citation Formats

Dorresteijn, Lucille, E-mail: L.Dorresteijn@mst.n, Vogels, Oscar, Leeuw, Frank-Erik de, Vos, Jan-Albert, Christiaans, Marleen H., Ackerstaff, Rob, and Kappelle, Arnoud C.. Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis. United States: N. p., 2010. Web. doi:10.1016/j.ijrobp.2009.06.045.
Dorresteijn, Lucille, E-mail: L.Dorresteijn@mst.n, Vogels, Oscar, Leeuw, Frank-Erik de, Vos, Jan-Albert, Christiaans, Marleen H., Ackerstaff, Rob, & Kappelle, Arnoud C.. Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis. United States. doi:10.1016/j.ijrobp.2009.06.045.
Dorresteijn, Lucille, E-mail: L.Dorresteijn@mst.n, Vogels, Oscar, Leeuw, Frank-Erik de, Vos, Jan-Albert, Christiaans, Marleen H., Ackerstaff, Rob, and Kappelle, Arnoud C.. Sun . "Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis". United States. doi:10.1016/j.ijrobp.2009.06.045.
@article{osti_21436110,
title = {Outcome of Carotid Artery Stenting for Radiation-Induced Stenosis},
author = {Dorresteijn, Lucille, E-mail: L.Dorresteijn@mst.n and Vogels, Oscar and Leeuw, Frank-Erik de and Vos, Jan-Albert and Christiaans, Marleen H. and Ackerstaff, Rob and Kappelle, Arnoud C.},
abstractNote = {Purpose: Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients. Methods and Materials: We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location. Results: Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis. Conclusions: The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.},
doi = {10.1016/j.ijrobp.2009.06.045},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 77,
place = {United States},
year = {2010},
month = {8}
}