Outcomes of Carotid Angioplasty and Stenting for Radiation-Associated Stenosis
Paul Harrod-Kima,
Yasha Kadkhodayana,
Colin P. Derdeyna,b,c,
DeWitte T. Cross, IIIa,b and
Christopher J. Morana,b
a Department of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, St. Louis, MO
b Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO
c Department of Neurology, Washington University School of Medicine, St. Louis, MO
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FIG 1. A case of long-term stent patency in patient 4, a 68-year-old woman with thyroidectomy for carcinoma followed by postoperative radiation, bilateral radical neck dissection, and permanent tracheostomy, who experienced transient ischemic changes in the left cerebral hemisphere 21 years after radiation therapy. The patient had a history of graft placement between her left CCA and left subclavian arteries (5 years before admission) as well as a right CCA vein graft bypass (10 years before admission).
A, Digital subtraction angiography (DSA) reveals a 70% stenosis (arrow) of the distal left CCA. Note the bypass graft (arrowhead) between the left CCA and left subclavian arteries.
B, Successful stent placement with little residual stenosis. The proximal end of the 8 x 40 mm Wallstent (Boston Scientific, Natick, MA) extends across the origin of the left subclavian graft (arrow). Poststent angioplasty with an 8 x 40 mm Olbert balloon (Boston Scientific) resulted in rupture of the balloon.
C, Repeat DSA 4.5 years after stent placement shows a patent carotid artery with interval auto expansion of the stent.
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FIG 2. A case of multiple restenting in patient 2, a 61-year-old man with bilateral radical neck dissection and external beam radiation for laryngeal cancer 15 years before right cerebral hemisphere stroke due to right ICA occlusion.
A, DSA shows an 85% ulcerated stenosis (arrow) of the proximal left ICA.
B, DSA after angioplasty and stent placement shows little residual stenosis. Prestent angioplasty was performed with a 4 x 20 mm Symmetry balloon (Boston Scientific). This was followed by placement of an 8 x 40 mm Wallstent (Boston Scientific). Poststent angioplasty was performed by using an 8 x 40 mm Olbert balloon (Boston Scientific).
C, Repeat DSA 5 years after stent placement shows 70% restenosis (arrow) in the distal left CCA at the inferior margin of the stent. The external carotid artery no longer fills.
D, DSA after angioplasty and stent placement with a 5 x 20 mm Savvy balloon (Cordis Corp., Miami Lakes, FL) followed by a 7 x 20 mm Precise stent (Cordis). There is minimal filling of the external carotid artery.
E, DSA 17 months later shows a focal high-grade in-stent restenosis (arrow) and a less severe stenosis in the CCA (arrowhead).
F, Immediate DSA following placement of a third stent (7 x 40 mm Precise; Cordis) and poststent angioplasty with a 6 x 40 Savvy balloon (Cordis) shows a good angiographic result.
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