Chun Kit Shiu MBBS, FRCR, Presenter: Nothing to Disclose

Joyce Pui Kwan Chan, Abstract Co-Author: Nothing to Disclose

Sherman Sheung Ming Lo MBBS, MPH, Abstract Co-Author: Nothing to Disclose

Wai Lun Poon MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

This retrospective study aims at comparing the short-term and long-term outcomes of carotid angioplasty and stenting (CAS) between patients suffering from radiation-associated carotid stenosis and those with atherosclerosis-associated stenosis.

All consecutive patients who underwent CAS in our institution for carotid stenosis between Jan 2008 and Dec 2013 were identified. According to any history of head and neck irradiation, patients were stratified into radiation treatment (XRT) or non-XRT group. All CAS were performed by a dedicated team of neurointerventionists. Standardized post-operative clinical and Doppler ultrasound follow-up were undertaken for all patients. Diagnostic angiograms were performed to confirm the restenosis (>70%) detected by Doppler studies. Procedural and clinical records were reviewed and any periprocedural events and long-term recurrent stroke were documented. Univariate and Kaplan-Meier analyses were performed for both groups.

114 CAS procedures were identified. There were 41 patients with 46 CAS in XRT group and 68 patients with 78 CAS in non-XRT group. 15 patients received bilateral CAS. Median follow-up for XRT and non-XRT were 25.6 and 24.8 months. XRT patients were younger (63.5 vs. 73.1 years; p<0.001) and with significantly less vascular risk factors. 37 (90%) XRT patients had irradiation for nasopharyngeal carcinoma. More XRT patients had CCA stenosis (52.1% vs. 6.4%; p<0.001) and significantly longer segment of stenosis. The perioperative events including stroke, myocardial infarction and mortality did not differ significantly between the two groups but only 1 (2.2%) patient in XRT had stroke compared with 8 (10.3%) in non-XRT. Although there was no statistically significant difference in long-term mortality and ipsilateral stroke between XRT and non-XRT group, likely due to a small sample size, a trend towards better outcomes in XRT group can be observed. Restenosis was significantly more common in XRT compared with non-XRT (p=0.043). Majority of the restenosis were asymptomatic.

This study shows the perioperative and long-term outcomes of CAS in radiation-associated stenosis are comparable to that in atherosclerotic stenosis, except for a higher restenosis rate.

CAS in radiation-associated stenosis is probably safe and efficacious and we recommend a more frequent follow-up in these patients due to a higher restenosis rate.

Shiu, C, Chan, J, Lo, S, Poon, W, Carotid Angioplasty and Stenting: Long-term Outcomes in Radiation Associated Stenosis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004181.html