Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Biomed J. 2013 May-Jun;36(3):144-9. doi: 10.4103/2319-4170.113232.
In Taiwan, the prevalence of head and neck cancer is relatively high. Because radiation-associated carotid stenosis is a significant risk factor for stroke, carotid artery stenting (CAS), instead of carotid endarterectomy, is indicated in patients with radiation-associated carotid stenosis. We sought to evaluate the effect of neck radiotherapy (XRT) on the long-term outcome of patients undergoing CAS.
From March 2001 to November 2011, 147 CAS procedures were performed on 129 patients (n = 43 for XRT, n = 86 for non-XRT). Mean follow-up was 42.7 ± 20.5 months (median: 52 months; range: 1-60 months). Duplex velocity criterion for > 50% restenosis after CAS was defined as peak systolic velocity > 175 cm/s. Endpoints included 5-year freedom from mortality, ipsilateral recurrent stroke, and major adverse cardiovascular events (MACE).
The mean age of XRT patients was significantly lesser than that of non-XRT patients (61 ± 8 vs. 71 ± 8, p < 0.001). There was significantly less coronary artery disease and other cardiovascular co-morbidities in XRT patients. No significant differences were noted in the composite 30-day ipsilateral stroke/myocardial infarction/mortality (XRT: 8.6% vs. non-XRT: 6%, p > 0.05) and 5-year freedom from mortality, ipsilateral recurrent stroke, and MACE (p > 0.05) between the two groups. Intra-stent carotid restenosis > 50% was significantly higher in the XRT group on follow-up.
Long-term outcomes of CAS for radiation-associated stenosis were not altered by a history of neck XRT, except for asymptomatic carotid restenosis.
在台湾，头颈部癌症的发病率相对较高。由于放射性颈动脉狭窄是中风的一个重要危险因素，因此对于放射性颈动脉狭窄的患者，建议采用颈动脉支架置入术（CAS）而非颈动脉内膜切除术。我们旨在评估颈部放疗（XRT）对接受 CAS 治疗的患者长期预后的影响。
2001 年 3 月至 2011 年 11 月，对 129 例患者（XRT 组 43 例，非 XRT 组 86 例）的 147 例 CAS 手术进行了评估。平均随访时间为 42.7±20.5 个月（中位数：52 个月；范围：1-60 个月）。CAS 后>50%再狭窄的双功能超声速度标准定义为收缩期峰值速度>175cm/s。终点包括 5 年死亡率、同侧复发性卒中以及主要不良心血管事件（MACE）的无事件发生率。
XRT 组患者的平均年龄明显小于非 XRT 组（61±8 岁 vs. 71±8 岁，p<0.001）。XRT 组患者的冠心病和其他心血管合并症明显较少。两组间 30 天内同侧卒中/心肌梗死/死亡率的复合事件（XRT：8.6% vs. 非 XRT：6%，p>0.05）以及 5 年死亡率、同侧复发性卒中以及 MACE 的无事件发生率均无显著差异（p>0.05）。随访时 XRT 组的支架内颈动脉再狭窄率>50%显著较高。
除无症状性颈动脉再狭窄外，颈部 XRT 病史并未改变 CAS 治疗放射性狭窄的长期预后。
