Department of Radiology, Taipei Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei 231, Taiwan; School of Medicine, Tzu Chi University, 701 Zhongyang Rd., Sec. 3, Hualien 970, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, No. 155, Sc. 2, Linong St., Beitou Dist., Taipei 112, Taiwan.
Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 112, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sc. 2, Linong St., Beitou Dist., Taipei 112, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sc. 2, Linong St., Beitou Dist., Taipei 112, Taiwan.
Eur J Radiol. 2023 Aug;165:110894. doi: 10.1016/j.ejrad.2023.110894. Epub 2023 May 26.
Post-irradiated carotid stenosis (PIRCS) commonly occurs in patients with nasopharyngeal cancer (NPC) after receiving radiotherapy. A high in-stent restenosis (ISR) is observed in these patients after percutaneous transluminal angioplasty and stenting (PTAS) for PIRCS. Risk factors for ISR in these patients remain unclear.
Data were retrospectively analyzed from 68 NPC patients with 70 lesions treated with PTAS for PIRCS. The median follow-up was 40 months (range: 4-120). Evaluations of demographic and clinical characteristics included stenotic severity, stenotic lesion length (SLL), stenotic lesion location, and ISR-related stroke during follow-up. The risk for ISR was evaluated using multiple Cox regression analysis.
The median age of the patients was 61 (35-80) years and 94.1% were male. The median stenosis was 80% (60-99%) and the median SLL was 2.6 cm (0.6-12.0 cm) before PTAS. Compared to those without ISR, patients with longer SLL were at significantly greater risk of developing significant ISR, defined as > 50% after PTAS (hazard ratio [HR] and 95% confidence interval [CI]: 2.06 [1.30-3.28]). PTAS for lesions from the internal carotid artery (ICA) to common carotid artery (CCA) was associated with a significantly greater risk of ISR than lesions located only in the ICA (HR: 9.58 [1.79-51.34]). The baseline cut-off value for SLL that best predicted significant ISR was 1.6 cm (area under the curve 0.700, sensitivity 83.3% and specificity 62.5%).
Stenotic lesions located from the ICA to CCA with longer SLL at baseline appear to predict ISR in NPC patients with PIRCS after PTAS. Intensive post-procedural follow-up is advised for this patient population.
鼻咽癌（NPC）患者接受放疗后常发生放射性颈动脉狭窄（PIRCS）。这些患者在接受经皮腔内血管成形术和支架置入术（PTAS）治疗 PIRCS 后，支架内再狭窄（ISR）发生率较高。目前尚不清楚这些患者发生 ISR 的危险因素。
回顾性分析了 68 例 NPC 患者 70 处病变接受 PTAS 治疗 PIRCS 的临床资料。中位随访时间为 40 个月（4-120 个月）。评估的人口统计学和临床特征包括狭窄严重程度、狭窄病变长度（SLL）、狭窄病变位置和随访期间与 ISR 相关的中风。采用多因素 Cox 回归分析评估 ISR 的风险。
患者中位年龄为 61 岁（35-80 岁），94.1%为男性。PTAS 前狭窄中位数为 80%（60-99%），SLL 中位数为 2.6cm（0.6-12.0cm）。与无 ISR 患者相比，SLL 较长的患者发生明显 ISR 的风险显著增加，定义为 PTAS 后>50%（风险比[HR]和 95%置信区间[CI]：2.06[1.30-3.28]）。PTAS 治疗颈内动脉（ICA）至颈总动脉（CCA）病变与仅治疗 ICA 病变相比，ISR 风险显著增加（HR：9.58[1.79-51.34]）。预测明显 ISR 的最佳 SLL 截断值为 1.6cm（曲线下面积 0.700，灵敏度 83.3%，特异性 62.5%）。
PTAS 治疗 PIRCS 后，位于 ICA 至 CCA 的狭窄病变且基线 SLL 较长的患者，似乎可预测 NPC 患者的 ISR。建议对此类患者进行强化的术后随访。
