Annals of vascular surgery · 2026
Restenosis after Carotid Artery Stenting in Radiation-induced versus Atherosclerotic Carotid Stenosis: 25-year experience from a tertiary hospital.
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Tam Jacky Siu-Chung, Fung Ngo-Yeung, Ling Pei-Zhi, Cheng Stephen W K
Аннотация
OBJECTIVE: To compare the long-term in-stent restenosis (ISR) rate following carotid artery stenting (CAS) in patients with carotid stenosis secondary to atherosclerosis (AS) and radiation-induced stenosis (RIS).
METHODS: A retrospective review was conducted on 140 CAS procedures in 126 patients at our institution over a 25-year period. Patients with prior neck irradiation were classified as RIS, while the remaining were categorized as AS. Propensity score matching was employed to balance baseline characteristics between the groups. Restenosis was evaluated using specific duplex ultrasound velocity criteria validated for stented arteries. Rates of moderate (≥50%) and severe (≥70%) in-stent restenosis were compared, and long-term restenosis-free survival was estimated using Kaplan-Meier analysis. Multivariate logistic regression was used to determine independent risk factors for ISR.
RESULTS: After matching, 40 CAS procedures were included in each group (RIS and AS). Median follow-up duration was 72 months. The RIS group exhibited a significantly higher prevalence of ≥50% ISR (40% vs. 12.5%; p=0.005) and a composite endpoint of ≥50% ISR or new stenosis outside the stented segment (55% vs. 17.5%; p<0.001). The estimated 2-year ISR-free survival at ≥50% was 75.5% in RIS compared to 94.8% in AS (p=0.005). Multivariate analysis identified prior neck irradiation as the sole independent risk factor for ≥50% ISR (OR 7.05, 95% CI 1.26-39.45, p=0.026). No significant risk factors were found for ≥70% ISR. Era-based analysis demonstrated a significant decrease in the incidence of ≥50% and ≥70% ISR in the RIS group during the more recent period, accompanied by shifts in baseline characteristics such as prevalence of hyperlipidema and statin use. Reintervention rate and late ipsilateral neurological events were comparable between the groups.
CONCLUSIONS: Radiation-induced carotid stenosis is associated with higher rates of long-term moderate (≥50%) in-stent restenosis following carotid artery stenting compared with atherosclerotic disease. However, reintervention and late ipsilateral neurological event rates remain comparable between groups. Recent temporal declines in restenosis coincide with increased statin use and optimized hyperlipidemia management.
METHODS: A retrospective review was conducted on 140 CAS procedures in 126 patients at our institution over a 25-year period. Patients with prior neck irradiation were classified as RIS, while the remaining were categorized as AS. Propensity score matching was employed to balance baseline characteristics between the groups. Restenosis was evaluated using specific duplex ultrasound velocity criteria validated for stented arteries. Rates of moderate (≥50%) and severe (≥70%) in-stent restenosis were compared, and long-term restenosis-free survival was estimated using Kaplan-Meier analysis. Multivariate logistic regression was used to determine independent risk factors for ISR.
RESULTS: After matching, 40 CAS procedures were included in each group (RIS and AS). Median follow-up duration was 72 months. The RIS group exhibited a significantly higher prevalence of ≥50% ISR (40% vs. 12.5%; p=0.005) and a composite endpoint of ≥50% ISR or new stenosis outside the stented segment (55% vs. 17.5%; p<0.001). The estimated 2-year ISR-free survival at ≥50% was 75.5% in RIS compared to 94.8% in AS (p=0.005). Multivariate analysis identified prior neck irradiation as the sole independent risk factor for ≥50% ISR (OR 7.05, 95% CI 1.26-39.45, p=0.026). No significant risk factors were found for ≥70% ISR. Era-based analysis demonstrated a significant decrease in the incidence of ≥50% and ≥70% ISR in the RIS group during the more recent period, accompanied by shifts in baseline characteristics such as prevalence of hyperlipidema and statin use. Reintervention rate and late ipsilateral neurological events were comparable between the groups.
CONCLUSIONS: Radiation-induced carotid stenosis is associated with higher rates of long-term moderate (≥50%) in-stent restenosis following carotid artery stenting compared with atherosclerotic disease. However, reintervention and late ipsilateral neurological event rates remain comparable between groups. Recent temporal declines in restenosis coincide with increased statin use and optimized hyperlipidemia management.