Long-term Results Of Carotid Artery Stenting In Veterans With Prior Head And Neck Cancer
Roy W. Jones, MD, Adam Tanious, MD, Paul Armstrong, DO, Neil Moudgill, MD, Karl A. Illig, MD, James D. Brooks, MD.
University of South Florida, Tampa, FL, USA.
Objective(s): Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical radiation or neck dissection are considered "high risk" for carotid endarterectomy (CEA). This is a well-established indication for carotid artery stenting (CAS). The long-term outcomes of CAS in this population, however, are not so well-established. The purpose of this study was to review the long-term results of CAS in veteran patients with a prior history of treatment for head and/or neck cancer.
Methods: This is a retrospective review of a veteran patient population from 2000-2016. All patients at our institution with a prior history of treatment of head and/or neck cancer who underwent CAS were included in the analysis. During this time period, 38 patients met inclusion criteria and were treated with 50 carotid stenting interventions. Kaplan-Meier analysis was used to determine freedom from mortality and primary patency. The secondary aim was to identify predictive risk factors for mortality and reintervention.
Results: At 5 years, freedom from mortality was 60%. Mean length of time from procedure to death was 1281.6 (+/- 1599) days. Primary patency at 5 years was 89%. No neurologic events occurred at 30-days. Two patients suffered a stroke in long-term follow-up. The reintervention rate was 8% (n=4) with an assisted primary patency rate of 100%. No stent occlusions occurred in this series. Eleven of fourteen patients died of either recurrent, active index, or other distinct primary cancer. Mortality and need for reintervention were not predicted by type of cancer, TNM stage at initial diagnosis, indication for surgery (irradiation, neck dissection or both), pre-operative symptom-status, or pre-operative demographic variables.
Conclusions: Based on the results in this series, CAS in these patients can be performed with low long-term rates of neurologic events and need for reintervention. However, the survival of patients with head and neck cancer undergoing CAS in this cohort is reduced compared to published outcomes of other large series undergoing CAS for all indications. In this specific patient population, a more critical analysis of the patientís overall prognosis, especially as relates to cancer, should be undertaken prior to offering CAS.
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