Xu Xiaohui, Huang Feihong, Shi Xuan, Liu Rui, Han Yunfei, Li Min, Wang Fang, Yang Qingwen, Zhu Wusheng, Ye Ruidong, Liu Xinfeng
Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Neurology, The First School of Clinical Medicine, Jinling Hospital, Southern Medical University, Nanjing, China.
Front Neurosci. 2022 Apr 27;16:861511. doi: 10.3389/fnins.2022.861511. eCollection 2022.
Cervical radiotherapy can lead to accelerated carotid artery stenosis, increased incidence of stroke, and a higher rate of in-stent restenosis in irradiated patients. Our objective was to reveal the morphological characteristics of radiation-induced carotid stenosis (RICS) and the stent-vessel interactions in patients with previous cervical radiotherapy by optical coherence tomography (OCT).
Between November 2017 and March 2019, five patients with a history of cervical radiotherapy were diagnosed with severe carotid artery stenosis and underwent carotid artery stenting (CAS). OCT was conducted before and immediately after the carotid stent implantation. Two patients received OCT evaluation of carotid stenting at 6- or 13-month follow-up.
The tumor types indicating cervical radiotherapy were nasopharyngeal carcinoma ( = 3), cervical esophageal carcinoma ( = 1), and cervical lymphoma ( = 1). The median interval from the radiotherapy to the diagnosis of RICS was 8 years (range 4-36 years). Lesion characteristics of RICS were detected with heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis upon OCT evaluation. Post-interventional OCT revealed 18.2-57.1% tissue protrusion and 3.3-13.8% stent strut malapposition. Follow-up OCT detected homogeneous signal-rich neointima and signal-poor regions around stent struts. In the patient with high rates of tissue protrusion and stent strut malapposition, the 6-month neointima burden reached 48.9% and microvessels were detected.
The morphological features of RICS were heterogeneous, including heterogeneous signal-rich tissue, dissection, and advanced atherosclerosis. Stenting was successful in all 5 patients with severe RICS. One patient, with high rates of tissue protrusion and stent strut malapposition immediately after stenting, received in-stent neointimal hyperplasia at a 6-month follow-up.
颈部放疗可导致接受放疗患者的颈动脉加速狭窄、中风发生率增加以及支架内再狭窄率升高。我们的目的是通过光学相干断层扫描（OCT）揭示既往颈部放疗患者放射性颈动脉狭窄（RICS）的形态学特征以及支架与血管的相互作用。
2017年11月至2019年3月期间，5例有颈部放疗史的患者被诊断为严重颈动脉狭窄并接受了颈动脉支架置入术（CAS）。在颈动脉支架植入术前和术后即刻进行OCT检查。2例患者在6个月或13个月随访时接受了颈动脉支架置入术的OCT评估。
提示颈部放疗的肿瘤类型为鼻咽癌（n = 3）、颈段食管癌（n = 1）和颈部淋巴瘤（n = 1）。从放疗至诊断为RICS的中位间隔时间为8年（范围4 - 36年）。OCT评估发现RICS的病变特征为富含信号的异质性组织、夹层和晚期动脉粥样硬化。介入后OCT显示组织突出率为18.2% - 57.1%，支架支柱贴壁不良率为3.3% - 13.8%。随访OCT检测到支架支柱周围有富含信号的均匀新生内膜和信号缺失区域。在组织突出率和支架支柱贴壁不良率较高的患者中，6个月时新生内膜负荷达到48.9%，并检测到微血管。
RICS的形态学特征具有异质性，包括富含信号的异质性组织、夹层和晚期动脉粥样硬化。所有5例严重RICS患者的支架置入均成功。1例患者在支架置入后即刻组织突出率和支架支柱贴壁不良率较高，在6个月随访时出现支架内新生内膜增生。
