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Home > Vascular Annual Meeting > PP13. Prior Cervical Radiation Predicts Reduced...

PP13. Prior Cervical Radiation Predicts Reduced Durability of CAS

Jonathan A. Schor1, Indu Kapadia2, Zafar Jamil1, Ellie Y. Chakhtura2, Peter J. Pappas1, Brajesh K. Lal1
1UMDNJ-New Jersey Medical School, Newark, NJ; 2St Michaels Medical Center, Newark, NJ

OBJECTIVES: Carotid endarterectomy (CEA) in the setting of prior cervical radiation is technically challenging with increased periprocedural complications. As a result, cervical radiation is considered an indication for carotid artery stenting (CAS). Recent small analyses of CAS in these patients report higher primary thrombosis, stroke and restenosis rates. We assessed whether prior radiation was a predictor of poor outcome after CAS and investigated possible reasons for this interaction.

METHODS: Demographic, clinical, lesion, procedural, and outcome data were collected prospectively in patients undergoing CAS from 1996-2008. Univariate comparisons were made between patients with and without a history of prior radiation. The endpoints were rates of stroke/death/MI, in-stent restenosis (ISR)>50%, and target lesion revascularization (TLR). Multivariate logistic regression was used to assess if RT was an independent predictor of adverse outcomes

RESULTS: 64 patients underwent CAS; 37 (10.1%) had a history of cervical radiation (RT). They did not differ from those without radiation (NRT) with respect to age, gender, smoking, symptoms, or prior CEA. RT patients had a lower incidence of hypertension, diabetes, and CAD vs. NRT. Primary thrombosis did not occur in either group. 30-day stroke/death/MI occurred in 5.4% of RT vs. 5.8% of NRT (p=ns). The ISR rate was 21.6% for RT vs. 7.6% for NRT (p=.01). 18.9% of RT required TLR vs. 4.7% for NRT (p=.002). Multivariate analysis showed that radiation (OR=2.3) and prior CEA (OR=2.1) were independent risk factors for ISR. Radiation remained a predictor of ISR despite controlling for prior CEA. Radiation (OR=4.4), prior CEA (OR=2.1), and >1 stent placed (OR=8.8) predicted the need for TLR. Radiation was still a predictor of TLR despite controlling for the other factors

CONCLUSIONS: Peri-procedural complications are not increased for CAS in patients with prior cervical radiation. Radiation reduces the durability of CAS, increasing ISR and TLR rates. It predicts ISR and TLR despite correction for other patient and technical factors. Radiation-associated carotid lesions can be long and multifocal, requiring longer and multiple stents. History of radiation and the use of multiple stents contribute additively to increased luminal narrowing and therefore TLR in these patients.

AUTHOR DISCLOSURES: J.A. Schor, None; I. Kapadia, None; Z. Jamil, None; E.Y. Chakhtura, None; P.J. Pappas, None; B.K. Lal, CREST, NIH, NINDS.