Sano Noritaka, Satow Tetsu, Maruyama Daisuke, Kataoka Hiroharu, Morita Ken-ichi, Ishibashi-Ueda Hatsue, Iihara Koji
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
J Vasc Surg. 2015 Aug;62(2):370-7.e1. doi: 10.1016/j.jvs.2015.03.021. Epub 2015 Apr 30.
This study aimed to elucidate the relationships between preoperative carotid imaging results, histologic characteristics, and surgical treatment outcomes of radiation-induced carotid stenosis (RICS), using control subjects without RICS for comparison.
We retrospectively reviewed records of 17 patients who underwent carotid revascularization for 22 instances of RICS, including 10 cases of carotid artery stenting (CAS), 11 cases of carotid endarterectomy (CEA), and 1 case of CEA with retrograde CAS, between July 2004 and April 2013. The controls were 475 patients with no history of radiation therapy who underwent carotid revascularization in a similar period. Preoperative magnetic resonance imaging (MRI), ultrasonography (US), and computed tomography angiography results were correlated with outcomes of histologic analysis of CEA specimens. End points included ipsilateral and contralateral stroke, myocardial infarction, restenosis, in-stent thrombosis, and target lesion revascularization.
Vulnerable plaques on carotid MRI (86% vs 64.2%; P = .010) and mobile (27% vs 8.0%; P = .008) and ulcerative (50% vs 15.8%; P < .001) plaques on US were more frequent in the RICS group. All revascularization procedures were successful, and no occlusion occurred. Adverse events in the CAS group, including one minor stroke and one transient ischemic attack within 30 days as well as five ipsilateral neurologic events after 30 days, including three minor strokes and two transient ischemic attacks, were significantly more frequent than in the CEA group. All three cases of late ipsilateral stroke displayed vulnerable plaque on preoperative MRI and late in-stent thrombosis or restenosis on US.
Our radiologic and histologic analyses revealed that advanced RICS is often accompanied by formation of vulnerable plaque. CEA can prevent undesirable late outcomes in such cases.
本研究旨在阐明放射性颈动脉狭窄（RICS）患者术前颈动脉成像结果、组织学特征与手术治疗效果之间的关系，并与无RICS的对照受试者进行比较。
我们回顾性分析了2004年7月至2013年4月期间17例因22例RICS接受颈动脉血运重建术患者的记录，其中包括10例颈动脉支架置入术（CAS）、11例颈动脉内膜切除术（CEA）以及1例逆行CAS联合CEA。对照组为同期475例无放疗史且接受颈动脉血运重建术的患者。术前磁共振成像（MRI）、超声检查（US）和计算机断层血管造影结果与CEA标本的组织学分析结果相关。终点指标包括同侧和对侧卒中、心肌梗死、再狭窄、支架内血栓形成以及靶病变血运重建。
RICS组颈动脉MRI上易损斑块（86%对64.2%；P = 0.010）以及US上的活动斑块（27%对8.0%；P = 0.008）和溃疡性斑块（50%对15.8%；P < 0.001）更为常见。所有血运重建手术均成功，未发生闭塞。CAS组的不良事件，包括30天内1例轻度卒中、1例短暂性脑缺血发作以及30天后5例同侧神经事件，包括3例轻度卒中和2例短暂性脑缺血发作，显著多于CEA组。所有3例晚期同侧卒中在术前MRI上均显示易损斑块，在US上显示晚期支架内血栓形成或再狭窄。
我们的影像学和组织学分析表明，晚期RICS常伴有易损斑块形成。在此类病例中，CEA可预防不良的晚期结局。
