Percutaneous transluminal angioplasty and stenting of post-irradiated stenosis of subclavian artery: A matched case-control study

IF 3 3区 医学 Q2 CLINICAL NEUROLOGY Journal of Neuroradiology Pub Date : 2024-02-01 DOI:10.1016/j.neurad.2023.06.004
Chun-Chao Huang , Hsin-Fan Chiang , Cheng‑Chih Hsieh , Hui-Chen Lin , Chia-Hung Wu , Te-Ming Lin , Jung-Hsuan Chen , Chao-Bao Luo , Feng-Chi Chang
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Abstract

Background

Although radiotherapy is common for head/neck and chest cancers (HNCC), it can result in post-irradiation stenosis of the subclavian artery (PISSA). The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) to treat severe PISSA is not well-clarified.

Aims

To compare the technical safety and outcomes of PTAS between patients with severe PISSA (RT group) and radiation-naïve counterparts (non-RT group).

Methods

During 2000 and 2021, we retrospectively enrolled patients with severe symptomatic stenosis (>60%) of the subclavian artery who underwent PTAS. The rate of new recent vertebrobasilar ischaemic lesions (NRVBIL), diagnosed on diffusion-weight imaging (DWI) within 24 h of postprocedural brain MRI; symptom relief; and long-term stent patency were compared between the two groups.

Results

Technical success was achieved in all 61 patients in the two groups. Compared with the non-RT group (44 cases, 44 lesions), the RT group (17 cases, 18 lesions) had longer stenoses (22.1 vs 11.1 mm, P = 0.003), more ulcerative plaques (38.9% vs 9.1%, P = 0.010), and more medial- or distal-segment stenoses (44.4% vs 9.1%, P<0.001). The technical safety and outcome between the non-RT group and the RT group were NRVBIL on DWI of periprocedural brain MRI 30.0% vs 23.1%, P = 0.727; symptom recurrence rate (mean follow-up 67.1 ± 50.0 months) 2.3% vs 11.8%, P = 0.185; and significant in-stent restenosis rate (>50%) 2.3% vs 11.1%, P = 0.200.

Conclusion

The technical safety and outcome of PTAS for PISSA were not inferior to those of radiation-naïve counterparts. PTAS for PISSA is an effective treatment for medically refractory ischaemic symptoms of HNCC patients with PISSA.

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锁骨下动脉放射后狭窄的经皮腔内血管成形术和支架植入术:匹配病例对照研究
背景虽然放疗是头颈部和胸部癌症(HNCC)的常见治疗方法,但放疗可能导致锁骨下动脉放疗后狭窄(PISSA)。目的 比较重度 PISSA 患者(RT 组)和放射治疗无效患者(非 RT 组)PTAS 的技术安全性和疗效。方法 2000 年至 2021 年期间,我们回顾性地纳入了接受 PTAS 的锁骨下动脉重度无症状狭窄(60%)患者。比较了两组患者术后 24 小时内脑核磁共振弥散加权成像(DWI)诊断的新近椎基底动脉缺血性病变(NRVBIL)发生率、症状缓解率和支架长期通畅率。与非 RT 组(44 例,44 个病灶)相比,RT 组(17 例,18 个病灶)的血管狭窄时间更长(22.1 mm vs 11.1 mm,P = 0.003),溃疡性斑块更多(38.9% vs 9.1%,P = 0.010),内侧或远端血管狭窄更多(44.4% vs 9.1%,P<0.001)。非 RT 组与 RT 组的技术安全性和结果分别为:围手术期脑 MRI DWI 上的 NRVBIL 为 30.0% vs 23.1%,P = 0.727;症状复发率(平均随访 67.1 ± 50.0 个月)为 2.结论PISSA的PTAS的技术安全性和结果并不逊色于未接受放射治疗的同行。PISSA的PTAS是治疗HNCC患者PISSA药物难治性缺血症状的有效方法。
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来源期刊
Journal of Neuroradiology
Journal of Neuroradiology 医学-核医学
CiteScore
6.10
自引率
5.70%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.
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