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Sténose carotidienne post-irradiation cervicale : une approche personnalisée
- Source :
- JMV-Journal de Médecine Vasculaire. 42:263-271
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Introduction Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). Methods We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. Results RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. Conclusion Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.
- Subjects :
- medicine.medical_specialty
business.industry
Carotid arteries
Technical success
Radiation induced
030204 cardiovascular system & hematology
medicine.disease
Surgery
03 medical and health sciences
Stenosis
0302 clinical medicine
Restenosis
Cranial Nerve Injury
Medicine
Myocardial infarction
Cardiology and Cardiovascular Medicine
business
Stroke
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 25424513
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- JMV-Journal de Médecine Vasculaire
- Accession number :
- edsair.doi...........f4e94bcd2d67c6b40d127533b3ee7065