Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis. Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter [J Vasc Surg] Journal article | | Title | Carotid angioplasty and stenting in anatomically high-risk patients: Safe and durable except for radiation-induced stenosis. | | Author(s) | Shin SH, Stout CL, Richardson AI, DeMasi RJ, Shah RM, Panneton JM | | Institution | Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA. | | Source | J Vasc Surg 2009 Oct; 50(4):762-7; discussion 767-8. | | MeSH | Aged
Angioplasty, Balloon
Blood Vessel Prosthesis Implantation
Carotid Stenosis
Cohort Studies
Comorbidity
Feasibility Studies
Female
Follow-Up Studies
Graft Occlusion, Vascular
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Probability
Radiation Injuries
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stents
Survival Rate
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Patency
| | Abstract | OBJECTIVE: Carotid angioplasty and stenting (CAS) is used in patients considered high-risk for carotid endarterectomy (CEA). Patients qualify as high-risk because of medical comorbid conditions or for anatomic considerations (previous CEA, radical neck dissection, radiation). We compared the technical feasibility and durability of CAS in medically high-risk patients (MED) vs anatomically high-risk patients (ANAT).
METHODS: A retrospective review was performed of all consecutive patients undergoing CAS by a single vascular surgery group. All patients were high risk and evaluated with duplex ultrasound imaging and angiography. Primary end points were technical success, 30-day stroke, myocardial infarction (MI), death, and in-stent restenosis. Standard statistical analysis included Kaplan-Meier life tables.
RESULTS: From January 2003 to December 2007, 230 CAS (98 ANAT, 132 MED) procedures were attempted. The ANAT cohort comprised 84 patients with a single anatomic risk factor: 71 with a previous ipsilateral CEA, 6 high lesions, 6 history of neck radiation, and 1 with a tracheostomy. Ten patients had two or three anatomic risk factors: nine with radical neck dissection and radiation and one with neck radiation and ipsilateral CEA. The mean age was 71.1 years for ANAT vs 73.9 years for MED (P = .021). Technical success rates were 98% in ANAT and 98.5% in MED (P = .76). Thirty-day stroke rate was 1.0% in ANAT and 5.3% in MED (P = .14); the mortality rate was 2.0% in ANAT and 0.8% in MED (P = .79). The 2-year survival free from stroke was MED, 93.6% and ANAT, 98.9% (P = .118); and from restenosis was MED, 91.9%; and ANAT, 91.0% (P = .98). Two-year overall survival was significantly better in ANAT (84.6%) vs MED (70.1%; P = .026). Four of the seven restenoses in the ANAT group occurred in patients with previous neck radiation. The restenosis rate for radiation-induced (RAD) stenosis treated with CAS was significantly higher at 22.2% (4 of 18) compared with 3.8% (3 of 78) in ANAT group patients without a history of radiation (non-RAD; P = .028). The 2-year restenosis-free survival was 72.7% in the RAD group vs 95.9% in the non-RAD group (P = .017).
CONCLUSION: CAS is as technically feasible, safe, and durable in anatomically high-risk patients as in medically high-risk patients, with similar rates of periprocedural stroke and death and late restenosis. However, patients with radiation-induced stenosis appear to be at an increased risk for restenosis. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
| | PubMed ID | 19786237 |
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