Carotid Stenting for Radiation-Induced Extracranial Carotid Artery Occlusive Disease:Efficacy and Midterm Outcomes

Radiation-induced carotid artery stenosis: a comprehensive review of the literature

In recent decades, with the improvement of radiotherapy (RT) technology and comprehensive treatment, the survival rate of head and neck malignancies has gained remarkable progress. Vascular injury and subsequent carotid stenosis following RT, as the backbone of treatment, have received increasing attention. Many investigations have demonstrated that radiation can result in the increase in carotid intima-media thickness, carotid stenosis and consequently lead to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. In this review, we will examine the incidence of radiation-induced carotid artery stenosis, its morphological and histological characteristics, as well as its pathogenesis. The treatment and prevention methods, including follow-up strategies, will also be discussed at the end of the present review.

[Percutaneous transluminal angioplasty of radiotherapy induced carotid stenosis--case report]

Frequent delayed effect of radiation therapy in the region of neck is stenosis of carotid arteries. We report the case of 32 years old man with history of radiation therapy due to Hodgkin lymphoma, and severe stenosis of the right common carotid artery. Stenosis was succesfuly treated by percutaneous transluminal angioplasty with implantation of two bare-metal stents.

Endovascular management of carotid artery disease after radiation therapy and radical neck dissection

Object

More patients with head and neck cancers who undergo radical neck dissection and adjuvant radiation are experiencing prolonged survival times. Because of their improved survival, patients are living long enough to suffer the delayed effects of radiation therapy. Radiation-induced carotid artery (CA) stenosis in patients with or without radical neck dissection often requires extensive exposure and vessel reconstruction. The aim of this study was to evaluate the efficacy of endovascular treatment as an alternative therapy for radiation-induced CA stenosis.

Methods

Coinciding with the improved longevity of these patients, CA angioplasty and stent placement has become a definitive treatment strategy for this particularly challenging group of individuals. Long lesions are easily addressed with multiple telescoped stents. The tendency toward early restenosis can now be addressed with cutting balloon angioplasty. A review of the authors' institutional database yielded five patients (four men and one woman) with a history of radiation treatment ipsilateral to their CA stenosis. Three of five patients were symptomatic, and the interval between radiation therapy and endovascular treatment ranged from 1 to 47 years (mean 16.6 years). Four of the five patients were treated using distal embolic protection devices, and all patients underwent balloon dilation after stent placement.

Conclusions

As advancements are made in the technology and techniques for CA angioplasty and stent placement, the safety and durability of treatments in patients with radiation-induced atherosclerotic disease will improve.