Safety benefits mean TCAR may be preferable approach in radiation-induced carotid stenosis

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SVSA study presented recently at the Vascular Annual Meeting (VAM; 14–17 June, National Harbor, USA) has found that the long-term outcomes of transcarotid artery revascularisation (TCAR) are “not significantly affected” by prior head and neck radiation. Owing to substantially increased risks of mortality with transfemoral carotid artery stenting (CAS), as well as both stroke and mortality with carotid endarterectomy (CEA), researchers believe TCAR “may be the preferred treatment modality for patients with radiation-induced carotid stenosis”.

Bala Ramanan (University of Texas [UT] Southwestern Medical Center, Dallas, USA) delivered these findings from a study that sought to evaluate the effect of radiation on long-term outcomes after various carotid revascularisation techniques—TCAR, CAS and CEA—based on patients (≥65 years old) in the Society for Vascular Surgery’s (SVS) multicentre Vascular Quality Initiative (VQI) linked to the Vascular Implant Surveillance and Interventional Outcomes Network (VISION) database.

Primary endpoints in the study were three-year death, stroke and reintervention rates. From a total of 1,244 patients with prior radiation and 54,925 without prior radiation, the researchers performed propensity matching on 1,223 patients (CEA=655; TCAR=292; CAS=287).

Ramanan et al found no significant differences in 30-day outcomes for death, stroke, or major adverse cardiovascular events, across all three procedures—although the prior-radiation group had higher rates of cranial injury (3.7% vs 1.8%) and 90-day readmission (23.5% vs 18.3%) after CEA.

Prior radiation significantly increased mortality risks after CEA and CAS, and the three-year risk of stroke associated with CEA was also significantly higher in radiated patients compared to non-radiated patients. Prior radiation did not, however, significantly affect death or stroke in patients undergoing TCAR. The researchers also found that prior radiation did not impact the rates of short-and long-term reintervention after any of the three procedures.

“We plan to look at our institutional data to get more granular results regarding the long-term outcomes of patients undergoing revascularisation procedures for radiation-induced carotid stenosis,” Ramanan told Vascular Specialist. “However, since this is a relatively uncommon issue, we may need to pool data from multiple institutions to validate the results of the study.”


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