open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-16
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Revascularization approaches in patients with radiation-induced carotid stenosis: an updated systematic review and meta-analysis

Andreas Tzoumas, Dimitrios Xenos, Stefanos Giannopoulos, Marios Sagris, Damianos G Kokkinidis, Christos Bakoyiannis, Dimitrios Schizas
DOI: 10.33963/KP.15956
·
Pubmed: 33885270
·
Kardiol Pol 2021;79(6):645-653.

open access

Vol 79, No 6 (2021)
Original article
Published online: 2021-04-16

Abstract

Background: Ionizing radiation remains a well-known risk factor of carotid artery stenosis. The survival rates of head and neck cancer patients undergoing radiotherapy have risen owing to medical advancements in the field. As a consequence, the incidence of carotid artery stenosis in these high-risk patients has increased.
Aims: In this study we sought to compare the outcomes of carotid endarterectomy (CEA) vs carotid artery stenting (CAS) for radiation-induced carotid artery stenosis.
Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 2020. A random-effects model meta-analysis was conducted, and odds ratios (ORs) were calculated. The I-square statistic was used to assess for heterogeneity.
Results: Seven studies and 201 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, 7.40; 95% CI, 1.58–34.59; I2 = 0%). Analysis revealed no significant difference in terms of long-term mortality (OR, 0.41; 95% CI, 0.14–1.16; I2 = 0%) and restenosis rates (OR, 0.69; 95% CI, 0.29–1.66; I2 = 0%) between CEA and CAS after a mean follow-up of 40.5 months.
Conclusions: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results.

Abstract

Background: Ionizing radiation remains a well-known risk factor of carotid artery stenosis. The survival rates of head and neck cancer patients undergoing radiotherapy have risen owing to medical advancements in the field. As a consequence, the incidence of carotid artery stenosis in these high-risk patients has increased.
Aims: In this study we sought to compare the outcomes of carotid endarterectomy (CEA) vs carotid artery stenting (CAS) for radiation-induced carotid artery stenosis.
Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 2020. A random-effects model meta-analysis was conducted, and odds ratios (ORs) were calculated. The I-square statistic was used to assess for heterogeneity.
Results: Seven studies and 201 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, 7.40; 95% CI, 1.58–34.59; I2 = 0%). Analysis revealed no significant difference in terms of long-term mortality (OR, 0.41; 95% CI, 0.14–1.16; I2 = 0%) and restenosis rates (OR, 0.69; 95% CI, 0.29–1.66; I2 = 0%) between CEA and CAS after a mean follow-up of 40.5 months.
Conclusions: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results.

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Keywords

carotid stenosis, carotid artery stenting, carotid endarterectomy, endarterectomy, radiation

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About this article
Title

Revascularization approaches in patients with radiation-induced carotid stenosis: an updated systematic review and meta-analysis

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 79, No 6 (2021)

Article type

Original article

Pages

645-653

Published online

2021-04-16

DOI

10.33963/KP.15956

Pubmed

33885270

Bibliographic record

Kardiol Pol 2021;79(6):645-653.

Keywords

carotid stenosis
carotid artery stenting
carotid endarterectomy
endarterectomy
radiation

Authors

Andreas Tzoumas
Dimitrios Xenos
Stefanos Giannopoulos
Marios Sagris
Damianos G Kokkinidis
Christos Bakoyiannis
Dimitrios Schizas

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