Protected stent-assisted angioplasty in radiation-induced carotid artery stenosis

Author(s): Cohen JE, Rajz G, Lylyk P, Hur TB, Gomori JM, et al.

Abstract

Objective: The surgical treatment of radiation-induced carotid stenosis is challenging and presents a high rate of complications. This has led several investigators to propose stent-assisted angioplasty as the treatment of choice for this condition. The aim of this study is to evaluate the potential risks of intra-procedural embolic stroke in this setting using cerebral protection devices.

Methods: We describe our recent experience in the endovascular treatment by means of stent-assisted angioplasty with the aid of a filter cerebral protection device of eight patients presenting with radiation-induced carotid stenosis.

Results: Procedural success, defined as residual stenosis of less than 30% was obtained in all cases. The mean percentage stenosis was reduced from mean 80+/-6.3% (range 70-90%) to 13+/-4% (range 10-20%). Predilation was performed in five cases, post-dilation in all the cases. Mild-to-moderate bradycardia while inflating the balloon was present in three cases and was severe in one case. No patient sustained myocardial infarction, stroke or TIA during the procedure or hospital stay. During a mean clinical follow-up of 16+/-7.3 months (range 5-25) there were no neurological events. On sonographic follow-up, no patient presented in-stent de novo stenosis.

Discussion: Carotid angioplasty with cerebral protection can be performed safely in radiation-induced carotid stenosis with a high technical success rate. With the recent innovations and improvements in angioplasty technique, its indications and results will have to be redefined. Given the complexity and complications of surgical approaches for this condition, and the encouraging results obtained with endovascular techniques, carotid angioplasty emerges as the preferred treatment option.

Similar Articles

Incidence of carotid stenosis in nasopharyngeal carcinoma patients after radiotherapy

Author(s): Lam WW, Leung SF, So NM, Wong KS, Liu KH, et al.

Mcmurtrey, Carotidartery disease following external cervical irradiation

Author(s): Elerding SC, Fernandez RN, Grotta JC, Lindberg RD, Causay LC, et al.

Carotid stenosis after radiotherapy for nasopharyngeal carcinoma, Arch

Author(s): Cheng SWK, Ting ACW, Lam LKL, Wei WI

Angioplasty for Symptomatic Radiation?induced Extracranial Carotid Artery

Author(s): Ahuja A, Blatt GL, Guterman LR, Hopkins LN

Bilateral Carotid Stenting for Radiation-Induced Arterial Stenosis

Author(s): Ohta H, Sakai N, Nagata I, Sakai H, Higashi T, et al.

Carotid stenting for severe radiation-induced extracranial carotid artery occlusive disease

Author(s): Mubarak NA, Roubin GS, Iyer SS, Gomez CR, Liu MW, et al.

Outcome of carotid angioplasty and stenting for radiationassociated stenosis

Author(s): Kim PH, Kadkhodayan Y, Derdeyn CP, Moran CJ

A Management ofradiation-induced occlusive arterial disease: a reassessment

Author(s): Mellière D, Becquemin JP, Berrahal , Desgranges P, Cavillon

Adjuvant radiotherapy and chemotherapy in node—positive premenopausal women with breast cancer

Author(s): Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, et al.

Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries

Author(s): Halle M, Gabrielsen A, Paulsson-Berne G, Gahm C, Agardh HE, et al.

Clinical features of radiation-induced carotid atherosclerosis

Author(s): Gujral DM, Shah BN, Chahal NS, Senior R, Harrington KJ, et al.