Restenosis after Carotid Stent Placement in Patients with Previous Neck Irradiation or Endarterectomy

Purpose: Placement of a carotid artery stent (CAS) is an appealing treatment option for patients who have undergone neck irradiation or endarterectomy. Early outcomes and restenosis rates in these patients were analyzed and compared with those in de novo lesions. Materials and Methods: Single-center, retrospective review of 269 CAS procedures that used cerebral embolic protection and nitinol stents was conducted from May 2001 through July 2006. In this cohort, 66 procedures were performed in patients with a history of external-beam neck irradiation (n = 26) or carotid endarterectomy (CEA; n = 40), designated as the "hostile neck" group. Mean follow-up was 16 months. Results: The 30-day event rate for the entire group included major ipsilateral stroke (1.1%), minor posterior stroke (1.1%), and myocardial death (0.4%); none occurred in the hostile neck group. The rate of restenosis or occlusion for all 269 arteries was 2.6%. There was no significant difference in restenosis or occlusion rates between de novo lesions (2.0%, four of 203) and the hostile neck group (4.5%, three of 66; P = .17). Repeat angioplasty with or without stent implantation was employed for all patients with restenosis and resulted in no periprocedural stroke, death, or subsequent restenosis. Conclusions: Periprocedural outcomes of CAS procedures are similar in de novo lesions as in patients with a history of neck irradiation or CEA. Importantly, restenosis requiring repeat intervention remains uncommon, and its incidence is comparable between groups.