Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1386-90. doi: 10.1016/j.ijrobp.2009.06.045. Epub 2010 Jan 29.
Patients who have been irradiated at the neck have an increased risk of symptomatic stenosis of the carotid artery during follow-up. Carotid angioplasty and stenting (CAS) can be a preferable alternative treatment to carotid endarterectomy, which is associated with increased operative risks in these patients.
We performed a prospective cohort study of 24 previously irradiated patients who underwent CAS for symptomatic carotid stenosis. We assessed periprocedural and nonprocedural events including transient ischemic attack (TIA), nondisabling stroke, disabling stoke, and death. Patency rates were evaluated on duplex ultrasound scans. Restenosis was defined as a stenosis of >50% at the stent location.
Periprocedural TIA rate was 8%, and periprocedural stroke (nondisabling) occurred in 4% of patients. After a mean follow-up of 3.3 years (range, 0.3-11.0 years), only one ipsilateral incident event (TIA) had occurred (4%). In 12% of patients, a contralateral incident event was present: one TIA (4%) and two strokes (12%, two disabling strokes). Restenosis was apparent in 17%, 33%, and 42% at 3, 12, and 24 months, respectively, although none of the patients with restenosed vessels became symptomatic. The length of the irradiation to CAS interval proved the only significant risk factor for restenosis.
The results of CAS for radiation-induced carotid stenosis are favorable in terms of recurrence of cerebrovascular events at the CAS site.
在随访期间，颈部接受过放射治疗的患者发生颈动脉症状性狭窄的风险增加。颈动脉血管成形术和支架置入术（CAS）可能是这些患者的首选替代治疗方法，因为颈动脉内膜切除术与之相关的手术风险增加。
我们对 24 例先前接受过 CAS 治疗的症状性颈动脉狭窄的放射治疗后患者进行了前瞻性队列研究。我们评估了围手术期和非手术期事件，包括短暂性脑缺血发作（TIA）、非致残性中风、致残性中风和死亡。通过双功超声扫描评估通畅率。再狭窄定义为支架部位狭窄>50%。
围手术期 TIA 发生率为 8%，围手术期中风（非致残性）发生率为 4%。平均随访 3.3 年（范围 0.3-11.0 年）后，仅发生 1 例同侧（TIA）事件（4%）。在 12%的患者中，出现了对侧（TIA 1 例，4%；中风 2 例，12%，均为致残性）事件。再狭窄在 3、12 和 24 个月时分别为 17%、33%和 42%，但无再狭窄血管的患者均无症状。放射治疗至 CAS 间隔的长度是再狭窄的唯一显著危险因素。
CAS 治疗放射性颈动脉狭窄的结果在 CAS 部位复发性脑血管事件方面是有利的。
