Higher Risk For Reintervention In Patients After Stenting For Radiation Induced Carotid Artery Stenosis: A Single Center Analysis And Systematic Review
Erben Y,1* Franco-Mesa C,1* Miller D,2 Lanzino G,3 Bendok BR,4 Li Y,5 Sandhu SJS,2 Barrett KM,7 Freeman WD,6,7 Lin M,7 Huang JF,7 Huynh T,2 Farres H,1 Brott TG,7 Hakaim AG,1 Brigham TJ,9 Tawk RG,6 Meschia JF7
1Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL, 2Department of Radiology, Mayo Clinic, Jacksonville, FL, 3Department of Neurological Surgery, Mayo Clinic, Rochester, MN, 4Department of Neurological Surgery, Mayo Clinic, Scottsdale, AZ, 5Department of Political Science and Economics, Rowan University, Glassboro, NJ, 6Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, 7Department of Neurology, Mayo Clinic, Jacksonville, FL, 8Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, 9Mayo Clinic Libraries, Mayo Clinic, Jacksonville, FL
Objective: To review short- and long-term outcomes of all carotid artery stenting(CAS) in patients with radiation induced (RI) internal carotid artery (ICA) stenosiscompared with patients with atherosclerotic stenosis (AS).Methods: We performed a single-center, multi-site case-control study of carotidartery intervention in patients stented for RI or AS. Cases of stented RI wereidentified using a CAS database covering 01/2000-12/2019 and matched 2:1 withstented AS for age, sex and year of CAS. Multivariable logistic regression analysiswas performed to identify predictors of re-intervention. Lastly, a systematic reviewwas performed regarding outcomes of RI stenosis treated with CAS.Results: There were 120 CAS in 113 patients due to RI ICA stenosis. 89 (78.8%)were male and 68 (60.2%) were symptomatic. Reasons for radiation included mostcommonly treatment for diverse malignancies of the head and neck in 109 (96.5%)patients. Mean radiation dose was 58.9±15.6Gy and time from radiation to CASwas 175.3±140.4 months. Symptoms included 31 transient ischemic attacks (TIA),21 strokes (7 acute and 14 subacute) and 17 amaurosis fugax. Mean NationalInstitutes of Health Stroke Scale (NIHSS) in acute strokes was 8.7±11.2. Inasymptomatic patients, the indication for CAS was high grade stenosis determinedby duplex ultrasound. All CAS were successfully completed. Re-interventions weremore frequent in the RI ICA stenosis cohort compared with the AS cohort (10.1%versus 1.4%). Re-interventions occurred in 14 vessels and causes for re-intervention were restenosis in 12 followed by TIA/stroke in 2 vessels. Onmultivariable logistic regression analysis, patients with RI ICA stenosis were at ahigher risk for re-intervention (OR=7.1 [95% CI=2.1-32.8]; p=0.004). Mean follow-up was 33.7±36.9 months and mortality across groups was no different (p=0.12).Conclusion: In our single center, multi-site cohort study, patients who underwentCAS for RI ICA stenosis experienced a higher number of re-interventions. AlthoughCAS is safe and effective for this RI ICA stenosis cohort, careful surveillance iswarranted.
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