Vascular Surgery Department, University Hospital La Pitié-Salpêtrière, Paris, France.
Vascular Surgery Department, University Hospital La Pitié-Salpêtrière, Paris, France; Sorbonne Université Centre de recherche des Cordeliers, INSERM UMRS 1138, Paris, France.
J Vasc Surg. 2020 Sep;72(3):959-967. doi: 10.1016/j.jvs.2019.11.034. Epub 2020 Feb 5.
Carotid endarterectomy and carotid artery stenting are both valid therapeutic options for the treatment of radiation-induced carotid stenosis (RICS). The second has the advantage of being less invasive, although it seems to result in more restenosis than the first. Meanwhile, progress in radiation therapy and head and neck surgery has significantly increased the survival of these patients. As a result, treatment of RICS should be considered from a long-term perspective. This works presents perioperative and follow-up outcomes of surgical treatment of RICS.
This single-center retrospective study included all patients who underwent carotid endarterectomy for RICS from January 1998 to June 2017. Clinical and duplex ultrasound examination-based follow-up was performed postoperatively, at 1 month, 6 months, 12 months, and yearly thereafter. Kaplan-Meier curves were used for survival plots based on a log-rank test. Any abnormal finding led to angio-computed tomography scan and specialized neurovascular examination.
Between 1998 and 2017, 128 patients (162 lesions) were treated. The median interval between radiation therapy and surgery was 16 years. Forty-five patients (35%) were symptomatic. The eversion technique was performed in 79 cases (49%), and the patch was favored in 24 cases (15%), prosthetic bypass graft in 51 cases (31%), and a venous bypass graft in 8 cases (5%). Two postoperative deaths (1.5%) (one secondary to massive stroke) were noted. The primary end point of early postoperative cerebrovascular event was 2.5%. Two cervical hematomas (1.2%) required surgical revision and seven cases of permanent cranial nerve injury were recorded. The median follow-up was 29 months (range, 2-199 months). There were no additional strokes. The 3-year primary patency rate was 96% and the 3-year freedom from neurologic event was 98%.
Open surgical treatment of RICS lesions is a safe and durable option. Our results suggest that the outcomes of such treatment are good and in particular that rates of cerebrovascular event and restenosis are low and that cranial nerve injury should not be a concern. As a result, we consider that open surgery for RICS lesions should be offered as a first-line treatment. However, comparative data are mandated to address this issue.
颈动脉内膜切除术和颈动脉支架置入术都是治疗放射性颈动脉狭窄（RICS）的有效治疗选择。后者的优点是创伤较小，但似乎比前者更容易导致再狭窄。同时，放射治疗和头颈部手术的进展显著提高了这些患者的生存率。因此，从长期角度考虑 RICS 的治疗。本研究报告了 RICS 手术治疗的围手术期和随访结果。
这是一项单中心回顾性研究，纳入了 1998 年 1 月至 2017 年 6 月期间因 RICS 而行颈动脉内膜切除术的所有患者。术后、术后 1 个月、6 个月、12 个月和每年进行临床和双功能超声检查随访。基于对数秩检验的生存曲线采用 Kaplan-Meier 曲线。任何异常发现均导致血管计算机断层扫描和专门的神经血管检查。
1998 年至 2017 年间，共治疗了 128 名患者（162 处病变）。放疗和手术之间的中位间隔为 16 年。45 名患者（35%）有症状。79 例采用外翻技术（49%），24 例采用补片（15%），51 例采用人工旁路移植（31%），8 例采用静脉旁路移植（5%）。术后 2 例死亡（1.5%）（1 例继发于大面积中风）。早期术后脑血管事件的主要终点为 2.5%。2 例颈血肿（1.2%）需要手术修正，7 例记录到永久性颅神经损伤。中位随访时间为 29 个月（范围 2-199 个月）。无额外中风。3 年原发通畅率为 96%，3 年无神经事件率为 98%。
开放性手术治疗 RICS 病变是一种安全且持久的选择。我们的结果表明，这种治疗的结果良好，特别是脑血管事件和再狭窄的发生率较低，且颅神经损伤不应成为关注的问题。因此，我们认为应将开放性手术作为 RICS 病变的一线治疗方法。然而，需要比较数据来解决这个问题。
