醫學研究

腦血管病變 Cerebrovascular disease /中風 Stroke

Evaluation of carotid angioplasty and stenting for radiation-induced carotid stenosis

 

Yu SC, Zou WX, Soo YO, Wang L, Hui JW, Chan AY, Lee KT, Ip VH, Fan FS, Chan AL, Wong LK, Leung TW.  Stroke. 2014 May;45(5):1402-1407. doi: 10.1161/STROKEAHA.113.003995. Epub 2014 Apr 3. PMID: 24699055.

 

Abstract

 

Background and purpose: We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control.

 

Methods: In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR.

 

Results: The median follow-up was 47.3 months (95% confidence interval, 26.9-61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031).

 

Conclusions: The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR.

 

Clinical trial registration: This trial was not registered as enrollment started in 2006.

 

Keywords: carotid stenosis; head and neck neoplasms; outcome and process assessment (health care); radiotherapy.

 

 

Citation:

Yu SC, Zou WX, Soo YO, Wang L, Hui JW, Chan AY, Lee KT, Ip VH, Fan FS, Chan AL, Wong LK, Leung TW. Evaluation of carotid angioplasty and stenting for radiation-induced carotid stenosis. Stroke. 2014 May;45(5):1402-7. doi: 10.1161/STROKEAHA.113.003995. Epub 2014 Apr 3. PMID: 24699055.
 

https://pubmed.ncbi.nlm.nih.gov/24699055/

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