TUCSON, ARIZ. — Carotid angioplasty and stenting appear to be linked to a disproportionate rate of in-stent restenosis in patients with radiation-induced stenosis.
Radiation-induced stenosis was the only high-risk characteristic associated with less-than-optimal outcomes in a retrospective study that deemed the procedure a safe, durable alternative for patients at high risk for endarterectomy, Dr. Susanna H. Shin said at the annual meeting of the Southern Association for Vascular Surgery.
Her study involved 98 patients at anatomically high risk for carotid endarterectomy (CEA) and 132 patients at medically high risk. Anatomically high risk was defined as previous ipsilateral CEA, radical neck dissection, or neck irradiation; medically high risk was defined as multiple comorbidities.
The procedural success rate was 98% in the anatomically high-risk group and 98.5% in the medically high-risk group. Low rates of stroke, MI, and death were noted at 30 days in both cohorts. Stroke occurred in 1.0% of the anatomically high risk group and in 0.8% of the medically high risk group. The 30-day mortality rates were 2.0% and 0.8%, respectively. Stroke-free survival rates at 1 and 2 years were similar in the two cohorts, said Dr. Shin of Eastern Virginia Medical School, Norfolk.
Overall restenosis-free survival at 2 years was 91% in the anatomically high-risk group and nearly 92% in the medically high-risk cohort. Restenosis occurred in 4 (22%) of 18 patients with radiation-induced stenosis and in 3 (4%) of 78 of all other anatomically high-risk patients.
Various stents were used in the Norfolk series, said discussant Peter H. Lin of Baylor College of Medicine, Houston. Recent European studies suggest the patency rate with nitinol-based open stents is worse than with closed-cell stent designs. “I've seen this,” Dr. Lin said, adding that closed-cell stents could be applied in patients with certain anatomical risk factors such as radiation-induced stenosis.
Most patients in Dr. Shin's study received open-cell stents under clinical trial protocols.
Dr. Shin disclosed no conflicts; Dr. Lin has received research grants from device manufacturers.
Restenosis occurred in 22% of patients who had radiation-induced stenosis, vs. 4% of other patients. DR. SHIN