TY - JOUR
T1 - Relationship between histologic features and outcomes of carotid revascularization for radiation-induced stenosis
AU - Sano, Noritaka
AU - Satow, Tetsu
AU - Maruyama, Daisuke
AU - Kataoka, Hiroharu
AU - Morita, Ken Ichi
AU - Ishibashi-Ueda, Hatsue
AU - Iihara, Koji
N1 - Publisher Copyright:
© 2015 Society for Vascular Surgery.
Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Objective 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. Methods 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. Results 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. Conclusions 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.
AB - Objective 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. Methods 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. Results 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. Conclusions 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.
UR - http://www.scopus.com/inward/record.url?scp=84937816586&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937816586&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2015.03.021
DO - 10.1016/j.jvs.2015.03.021
M3 - Article
C2 - 25937602
AN - SCOPUS:84937816586
VL - 62
SP - 370-377.e1
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 2
ER -