Outcomes Of Carotid Artery Stenting In Patients With Radiation Arteritis Compared To Those With Atherosclerotic Disease
Omar Nadra, MD, Dylan Thibault, MS, Luke Marone, MD, Samantha Minc, MD.
WVU, Morgantown, WV, USA.
OBJECTIVES: Head and neck malignancies are often treated with radiation (XRT). 78% of patients receiving radiation will develop carotid radiation arteritis of some degree and 29% will develop a stenosis >50%. Surgery in a radiated neck has higher rates of complications and carotid artery stenting (CAS) is often the first choice for treatment. Outcomes for CAS in patients with radiation arteritis have not been rigorously evaluated. The objective of this study was to evaluate restenosis rates and long-term outcomes of XRT patients undergoing CAS compared to patients undergoing CAS for atherosclerotic disease. METHODS: The National VQI CAS dataset from 2016-2019 comprised the sample for analyses (N=7,218). The primary endpoint was freedom from mortality with secondary endpoints examining freedom from re-stenosis and re-intervention. The primary independent variable was previous neck XRT. Kaplan-Meier and multivariable Cox proportional hazard models were used to assess mortality. Whereas cumulative incidence functions (CIF) estimates were used for the non-fatal endpoints.
RESULTS: Approximately 17% of CAS cases had prior XRT (N=1,199). We found 3-year estimates of mortality to be 9.4% and 7.5% (p=0.026) for those with and without prior XRT respectively. Furthermore, on adjusted analysis (Figure 1), we observed a 75% increase in the risk of mortality for those with prior XRT (AHR: 1.75; 95%CI: 1.25-2.46). We did not observe any difference in the risk for restenosis or re-intervention, nor in the perioperative complications (MI, in-hospital mortality, ipsi- or contralateral stroke) for those with prior XRT compared to those without. CONCLUSIONS: CAS patients with XRT had significantly higher mortality at all time-points than those without XRT, even when adjusting for other co-variates. There was no significant difference in re-intervention, re-stenosis or perioperative complications rates between the two groups. This study is unique due to the large sample size and length of follow-up and suggests that for this high-risk group, CAS provides the same patency as it does for atherosclerotic disease patients while avoiding potentially morbid nerve injury.
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