Revascularization of radiation-induced carotid artery stenosis with carotid endarterectomy vs. carotid artery stenting: A systematic review and meta-analysis. [Review]

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 19(5 Pt B):638-644, 2018 Jul - Aug.PMID: 29422277Institution: MedStar Washington Hospital CenterDepartment: Medicine/General Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Carotid Stenosis/su [Surgery] | *Endarterectomy, Carotid | *Endovascular Procedures/is [Instrumentation] | *Head and Neck Neoplasms/rt [Radiotherapy] | *Radiation Injuries/su [Surgery] | *Stents | Aged | Carotid Stenosis/dg [Diagnostic Imaging] | Carotid Stenosis/et [Etiology] | Carotid Stenosis/mo [Mortality] | Endarterectomy, Carotid/ae [Adverse Effects] | Endarterectomy, Carotid/mo [Mortality] | Endovascular Procedures/ae [Adverse Effects] | Endovascular Procedures/mo [Mortality] | Female | Humans | Male | Middle Aged | Postoperative Complications/et [Etiology] | Radiation Injuries/dg [Diagnostic Imaging] | Radiation Injuries/et [Etiology] | Radiation Injuries/mo [Mortality] | Radiotherapy/ae [Adverse Effects] | Risk Assessment | Risk Factors | Treatment OutcomeYear: 2018Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: CONCLUSIONS: Patients with radiation-induced carotid artery stenosis can safely undergo both CAS and CEA with similar risks of periprocedural stroke, MI and death. However, patients treated with CEA have a higher risk for periprocedural CN injuries and a lower risk for long-term mortality.Copyright (c) 2018. Published by Elsevier Inc.MATERIALS & METHODS: This study was performed according to the PRISMA and MOOSE guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 20, 2017. A meta-analysis of random effects model was conducted. The I-square statistic was used to assess for heterogeneity.OBJECTIVE: The incidence of carotid artery stenosis after head and neck radiation is anticipated to rise due to the increasing survival of patients with head and neck malignancies. It remains unclear whether carotid artery stenting (CAS) or endarterectomy (CEA) is the best treatment strategy for radiation-induced carotid artery stenosis.RESULTS: Five studies and 143 patients were included. Periprocedural stroke, myocardial infarction (MI) and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR: 7.09; 95% CI: 1.17-42.88; I<sup>2</sup>=0%). CEA was associated with lower mortality rates after a mean follow-up of 50months (OR: 0.29; 95% CI: 0.09-0.97; I<sup>2</sup>=0%). No difference was identified in long-term restenosis rates between CEA and CAS.All authors: Giannopoulos S, Giannopoulos S, Jonnalagadda AK, Karasavvidis T, Kokkinidis DG, Texakalidis PFiscal year: FY2019Fiscal year of original publication: FY2018Digital Object Identifier: Date added to catalog: 2018-02-20
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29422277 Available 29422277

Available in print through MWHC library: 2002 - present

CONCLUSIONS: Patients with radiation-induced carotid artery stenosis can safely undergo both CAS and CEA with similar risks of periprocedural stroke, MI and death. However, patients treated with CEA have a higher risk for periprocedural CN injuries and a lower risk for long-term mortality.

Copyright (c) 2018. Published by Elsevier Inc.

MATERIALS & METHODS: This study was performed according to the PRISMA and MOOSE guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 20, 2017. A meta-analysis of random effects model was conducted. The I-square statistic was used to assess for heterogeneity.

OBJECTIVE: The incidence of carotid artery stenosis after head and neck radiation is anticipated to rise due to the increasing survival of patients with head and neck malignancies. It remains unclear whether carotid artery stenting (CAS) or endarterectomy (CEA) is the best treatment strategy for radiation-induced carotid artery stenosis.

RESULTS: Five studies and 143 patients were included. Periprocedural stroke, myocardial infarction (MI) and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR: 7.09; 95% CI: 1.17-42.88; I<sup>2</sup>=0%). CEA was associated with lower mortality rates after a mean follow-up of 50months (OR: 0.29; 95% CI: 0.09-0.97; I<sup>2</sup>=0%). No difference was identified in long-term restenosis rates between CEA and CAS.

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