Clinical Outcomes Following Carotid Intervention in Patients with Radiation-Induced Carotid Artery Stenosis: A propensity score-matched cohort study

Suren Jeevaratnam; James F Meschia; Josephine Huang; Camilo Polania-Sandoval; Camila Esquetini-Vernon; Mohamed Rajab; Kevin M Barrett; W Chris Fox; David A Miller; Thien Huynh; Xindi Chen; Christopher Jacobs; Richard D Beegle; Rabih Tawk; Sukhwinder J S Sandhu; Houssam Farres; Young Erben

doi:10.1016/j.avsg.2025.06.021

Clinical Outcomes Following Carotid Intervention in Patients with Radiation-Induced Carotid Artery Stenosis: A propensity score-matched cohort study

Ann Vasc Surg. 2025 Jun 27:S0890-5096(25)00441-8. doi: 10.1016/j.avsg.2025.06.021. Online ahead of print.

Authors

Suren Jeevaratnam¹, James F Meschia², Josephine Huang², Camilo Polania-Sandoval³, Camila Esquetini-Vernon³, Mohamed Rajab³, Kevin M Barrett², W Chris Fox⁴, David A Miller⁴, Thien Huynh⁴, Xindi Chen⁵, Christopher Jacobs³, Richard D Beegle⁶, Rabih Tawk⁴, Sukhwinder J S Sandhu⁶, Houssam Farres³, Young Erben⁷

Affiliations

¹ Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL; West Virginia School of Osteopathic Medicine, Lewisburg, WV.
² Department of Neurology, Mayo Clinic, Jacksonville, FL.
³ Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL.
⁴ Department of Neurosurgery, Mayo Clinic, Jacksonville, FL.
⁵ Mayo Clinic Alix School of Medicine, Jacksonville, FL.
⁶ Department of Radiology, Mayo Clinic, Jacksonville, FL.
⁷ Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL. Electronic address: erben.young@mayo.edu.

PMID: 40582456
DOI: 10.1016/j.avsg.2025.06.021

Abstract

Introduction: Radiation therapy, often combined with surgical excision. is widely used in treating head and neck neoplasms. A long-term consequence of this therapy is radiation-induced carotid artery stenosis (RICS), with incidence rates reaching 27%. This study aimed to compare clinical outcomes in patients who underwent transfemoral carotid artery stenting (TFCAS) with and without RICS. Secondly, we compared our institution's outcomes with those from the Southeastern Vascular Study Group (SEVSG).

Methods: We conducted a retrospective cohort study in adult patients undergoing TFCAS from 2015 to 2024. Patients were categorized as having RICS and no-RICS. The main outcome was the composite of stroke, transient ischemic attack (TIA), myocardial infarction (MI), or death at 30 days. Secondary outcomes included mid-term composite outcomes of stroke, MI, TIA, and death, and individual rates of restenosis and reinterventions. A 2:1 propensity score matching was performed using logistic regression to control for symptomatic status and diabetes mellitus.

Results: A total of 208 patients were included, with 177 in the no-RICS and 31 in the RICS group. After propensity score matching, 93 patients were compared. The 30-day composite outcome of ipsilateral stroke, TIA, MI, and death was not different between groups (no-RICS: 3.2% vs. RICS: 3.2%; p = 1.00). At mid-term follow-up, the composite outcome of ipsilateral stroke, TIA, MI, and death was not significantly different (no-RICS:16.1% vs. RICS:6.5%; p=0.19). There were no differences in the rate of restenosis (no-RICS: 22.6% vs. RICS: 12.9%; p=0.27) and reinterventions (no-RICS: 21% vs. RICS: 9.7%; p=0.17) between the groups. However, among the patients who needed reintervention, the RICS cohort had a significantly higher re-stenting rate than the no-RICS cohort (no-RICS: 0% vs. RICS: 6.5%, P=0.04). No significant difference was found when comparing the SEVSG dataset with our cohort in 30 days or mid-term outcomes.

Conclusion: TFCAS is a safe procedure for patients with RICS, as 30-day clinical outcomes, including stroke, TIA, MI, and death, do not differ from those in the no-RICS group. On mid-term follow-up, although the rate of reinterventions was not different among the cohorts, RICS patients had a significantly higher rate of re-stenting. In a larger cohort comparison, including the SEVSG, we found our institution's outcomes similar to those within our region.

Keywords: carotid artery stenosis; carotid endarterectomy; radiation; radiation-induced carotid artery stenosis; transfemoral carotid artery stenting.