Document Detail

Periprocedural outcomes after surgical revascularization and stenting for postradiotherapy carotid stenosis.
MedLine Citation:
PMID:  22819749     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Treatment of head and neck malignancy commonly involves radiotherapy, which is associated with the development of carotid artery stenosis. There is little evidence to guide clinicians on how to intervene in significant postradiotherapy carotid stenosis. This systematic review collated data pertaining to perioperative outcomes of carotid artery surgery and carotid stenting in postradiotherapy carotid stenosis to aid the clinical decision-making process.
METHODS: A systematic review of the literature, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines, was performed. We screened 575 articles related to carotid artery surgery or stenting in postradiotherapy carotid stenosis, from which 21 studies were included for quantitative analysis. The primary outcome was stroke or death ≤ 30 days of the procedure. Secondary outcomes included cranial nerve injury, restenosis, stroke, and death at >30 days.
RESULTS: Nine publications recorded 211 surgical procedures in 179 patients. In symptomatic patients, the 30-day mortality rate was 2.6% and the stroke or death rate was 2.7%. In asymptomatic patients, the 30-day mortality rate was 0% and the stroke or death rate was 1.1%. Permanent cranial nerve palsy was experienced by 0.6% of patients. Twelve publications recorded 510 carotid artery stenting procedures in 482 patients. In symptomatic patients, the 30-day mortality rate was 5.1%, and the stroke or death rate was 5.1%. In asymptomatic patients, the 30-day mortality rate was 1.4%, and the stroke or death rate was 2.1%. There was no statistically significant difference in 30-day stroke or death rate between surgical revascularization and carotid artery stenting in all (odds ratio [OR], 0.54; 95% confidence interval [CI] 0.17-1.70; P = .43), symptomatic (OR, 0.52; 95% CI, 0.14-1.98; P = .38), or asymptomatic patients (OR, 0.55; 95% CI, 0.06-5.42; P = .99).
CONCLUSIONS: The published outcomes from high-volume centers demonstrate that surgical revascularization and stenting are both technically feasible in postradiotherapy carotid stenosis and have similar safety profiles to nonirradiated necks. Radiation should therefore not be considered a contraindication to surgical intervention.
Veeru Kasivisvanathan; Ankur Thapar; Kerry J Davies; Brahman Dharmarajah; Joseph Shalhoub; Alun H Davies
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-07-21
Journal Detail:
Title:  Journal of vascular surgery     Volume:  56     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  2013-01-07     Revised Date:  2014-05-30    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1143-52.e2     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation*
Carotid Stenosis / etiology*,  therapy*
Head and Neck Neoplasms / radiotherapy
Radiotherapy / adverse effects*
Treatment Outcome
Grant Support
RCS/DMT 3RD ROUND (3)//The Dunhill Medical Trust

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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