Clinical Outcomes of Carotid Angioplasty and Stenting for Radiation-associated Carotid Artery Stenosis
CK Shiu, JPK Chan, KW Shek, PH Wong, SSM Lo, WL Poon, YL Cheung
Hong Kong J Radiol 2014;17:168-75
DOI: 10.12809/hkjr1414234
Objective: To investigate the procedural complication rate, restenosis rate, and clinical outcomes after carotid angioplasty and stenting in patients with radiation-associated carotid stenosis.
Methods: All patients with a history of head and / or neck radiation referred to Queen Elizabeth Hospital, Hong Kong, for carotid angioplasty and stenting for carotid artery stenosis between January 2008 and December 2013 were identified. Their clinical information, and procedural and imaging findings were reviewed. All procedures were performed by a dedicated team of neurointerventionists. The mean degree of stenosis was 75.1% (range, 50.0%-94.1%). Standardised, regular postoperative follow-up with clinical and Doppler ultrasound assessments was scheduled for all patients.
Results: Forty-five carotid arteries in 40 patients with a history of head and neck irradiation were stented in this study. The mean age was 63.3 years; 36 (90.0%) patients had radiotherapy for nasopharyngeal carcinoma. The mean time interval between radiotherapy and carotid angioplasty and stenting was 228.8 months (range, 8-487 months). The mean degree of stenosis was 75.1%. Fourteen (31.1%) patients who underwent carotid angioplasty and stenting had contralateral carotid artery occlusion. Embolic protection devices were used in 37 (82.2%) procedures. There was one (2.2%) procedural complication, with dissection of the left common carotid artery during catheterization for left internal carotid artery stenting. The mean follow-up period was 29 months (range, 1-66 months). The ipsilateral stroke-free survival rates were 97.8% at 6 months, 95.1% at 1 year, and 84.0% at 5 years. The restenosis-free survival rates were 95.0% at 6 months, 92.5% at 1 year, and 74.0% at 5 years. No 30-day mortality was identified. Two subarachnoid haemorrhages and one transient ischaemic attack occurred in the 30-day postoperative period. On subsequent follow-up, four (10.3%) patients died at a mean interval of 19 months after the procedure.
Conclusion: We demonstrated that carotid angioplasty and stenting is safe in patients with radiation-associated carotid artery stenosis. The long-term clinical outcomes of ischaemic neurological event and restenosis were satisfactory.
中文摘要
頸動脈支架置入血管成形術治療放射相關性頸動脈狹窄的臨床效果
蕭俊傑、陳君、石家偉、黃秉康、羅尚銘、潘偉麟、張毓靈
目的：探討頸動脈支架置入血管成形術（CAS）治療放射相關性頸動脈狹窄的術中併發症發生率、術後再狹窄率和臨床效果。
方法：本研究的對象均於2008年1月至2013年12月期間有頭部和/或頸部放射史，並因頸動脈狹窄須接受CAS而被轉介至香港伊利沙伯醫院的患者。本文回顧了病人的臨床資料、手術和影像學發現。所有手術均由一個神經介入醫生專科組進行。頸內動脈平均狹窄度為75.1%（介乎50.0%-94.1%）。為所有患者安排了標準化的術後定期隨訪，包括臨床和超聲多普勒評估。
結果：為40名有頭部和/或頸部放射史的患者的45條頸動脈內安裝了支架。患者平均年齡63.3歲；其中36人（90.0%）因鼻咽癌接受放射治療。放射治療與CAS的時間間隔為228.8個月（介乎8-487個月）。頸動脈平均狹窄度為75.1%。接受CAS的患者中，14人（31.1%）有對側頸內動脈阻塞。37例（82.2%）接受栓塞保護裝置。有1例（2.2%）出現術中併發症，於左頸內動脈支架置入術中插管時切開了左頸總動脈。平均隨訪時間為29個月（介乎1-66個月）。6個月、1年和5年的同側無中風生存率分別為97.8%、95.1%和84.0%。無再狹窄生存率分別為95.0%、92.5%和74.0%。30天死亡率為0%。術後30天內出現兩宗蛛網膜下腔出血和一宗短暫性腦缺血的病例。術後平均19個月內有4名患者（10.3%）死亡。
結論：本研究證明使用CAS治療放射相關性頸動脈狹窄是安全的。神經缺血性損傷和再狹窄治療的長期臨床結果令人滿意。