Outcomes of carotid artery stenting versus historical surgical controls for radiation- induced carotid stenosis Tiziano Tallarita, MD, Gustavo S. Oderich,

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Presentation transcript:

Outcomes of carotid artery stenting versus historical surgical controls for radiation- induced carotid stenosis Tiziano Tallarita, MD, Gustavo S. Oderich, MD, Giuseppe Lanzino, MD, Harry Cloft, MD, David Kallmes, MD, Thomas C. Bower, MD, Audra A. Duncan, MD, Peter Gloviczki, MD Journal of Vascular Surgery Volume 53, Issue 3, Pages 629-636.e5 (March 2011) DOI: 10.1016/j.jvs.2010.09.056 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 A 78-year-old male patient presented with a high grade carotid artery stenosis (A) with development of fresh thrombus (B, straight arrow) and new onset amaurosis fugax on a 2-week interval. The patient was treated with carotid endarterectomy and patch angioplasty with Bovine pericardial patch (C and D). Panel C shows high grade stenosis of the common carotid artery with adjacent fresh thrombus distal to the area of stenosis. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2, online only Technique of pectoralis major myocutaneous flap coverage based on the thoracoacromial pedicle (arrow). An island of skin and soft tissue is selected in the inframammary region. The flap is elevated by dividing the pectoralis muscle attachments from the anterior chest wall (inferiorly), sternum (medially), clavicle (superiorly), and the humerus (laterally). The flap is rotated 180 degrees and advanced through the subcutaneous tunnel up to the neck. Closed-drainage system is used in the anterior chest and neck wound. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3, online only Technique of carotid artery stenting (CAS) in a 77-year-old male with prior cervical irradiation, radical neck dissection, and tracheostomy who presented with progressive high-grade left common and internal carotid artery stenosis (A). Cervical angiography confirmed tandem lesions involving the left common carotid artery (B, two arrows) and the proximal internal carotid artery (B, curved arrow). Completion angiography (C) after CAS with good anatomical result. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Distribution of carotid, subclavian, and vertebral arteries stenosis in 60 patients who had undergone previous neck irradiation. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5, online only Kaplan-Meier estimates for patient survival among 60 patients treated for radiation-induced carotid stenosis with open carotid repair (OR, red) or carotid artery stenting (CAS, black). The dotted line denotes a standard deviation >10%. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 Kaplan-Meier estimates for freedom from neurologic event among 60 patients treated for radiation-induced carotid stenosis with open carotid repair (OR, red) or carotid artery stenting (CAS, black). The dotted line denotes a standard deviation >10%. Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 7 Kaplan-Meier estimates for freedom from restenosis (A) or reintervention (B) among 60 patients treated for radiation-induced carotid stenosis with open carotid repair (OR, red) or carotid artery stenting (CAS, black). Journal of Vascular Surgery 2011 53, 629-636.e5DOI: (10.1016/j.jvs.2010.09.056) Copyright © 2011 Society for Vascular Surgery Terms and Conditions