PMID: 26771867Jan 16, 2016Paper

Is a history of radiation therapy a contraindication for carotid surgery?

The Journal of Cardiovascular Surgery
Jan Albert VosJean Paul P M De Vries

Abstract

Advances in surgical and medical oncology have seen a significant increase in survival of patients suffering from head and neck malignancies. Many of these patients are treated with radiotherapy to the neck, including the cervical carotid artery. Cervical irradiation (CI) may induce carotid stenosis. Prior CI in association with carotid artery stenosis poses potential challenges, when revascularization is considered. As the focus of radiotherapy determines the level of the resultant obstruction it may be in a location that is difficult to reach surgically. Also scar tissue from CI may increase the risk of cranial nerve injury. Carotid angioplasty and stenting (CAS) may be an alternative for CEA in post CI cases. This manuscript aims to derive a treatment algorithm for post CI stenosis from the available literature, answering three questions: 1) do symptomatic post CI stenoses require revascularization?; 2) Do asymptomatic post CI stenoses require revascularization?; 3) What is the preferred revascularization modality? The answers to those questions are the following: 1) as several studies have shown the increased likelihood of stenosis after CI and its potential for embolic events, symptomatic stenosis should be treated; 2) pat...Continue Reading

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