| Objective:We aimed to evaluate the clinical and angiographic characteristics of symptomatic radiation induced cerebral artery stenosis(RICAS), as well as the safety and effectiveness of angioplasty and stenting for this form of stenosis using atherosclerotic stenosis as control.Methods:Those patients who were diagnosed with ischemic stroke or transient ischemic attack(TIA) were enrolled in this study in accord with the inclusion criteria. Carotid ultrasonography was performed firstly to evaluate the carotid intima media thickness(CIMT) and plaque characteristics. Then digital subtraction angiography(DSA) was performed to definite distribution of stenotic arteries and stenosis degree, as well as the plaque characteristics. Angioplasty and stenting was considered for patients according to the endovascular treatment criteria. Neurological function defect(national institutes of health stroke scale, NIHSS) on admission and at discharge and self-care ability(modified Rankin Scale score, m RS) at 3 months and 1 year after discharge were recorded.Results:1) 52 patients were enrolled in the study. 17 patients had a history of radiotherapy(RT group), 35 patients did not had the history of RT and were attributed to the control group. Two patients from the RT group were diagnosed as TIA. The mean interval from RT to ischemic stroke or TIA was 12.11 years.2) Diabetes mellitus was more common in the control group(11.8% vs 51.4%, p=0.006) and the plasma level of fibrinogen was higher in the RT group(9.08±17.53 vs 3.42±0.93, p=0.007).3) There was no significant difference in CIMT between the two groups(1.06±0.11 vs 1.13±0.26, p=0.350). DSA revealed 41 pathological vessels in the RT group and 83 in the control group. In the RT group, 30 stenotic arteries were from anterior circulation, including 15 arteries in the ICA, 8 arteries in the CCA, 7 arteries in the ECA; the remaining 11 stenotic arteries were from the posterior circulation, including 7 arteries in the VA and 4 arteries in the SA. In the control group, 59 stenotic arteries were from anterior circulation, including 38 arteries in the ICA, 10 arteries in the CCA, 4 arteries in the ECA and 7 arteries in the MCA; the remaining 24 stenotic arteries were from the posterior circulation, including 21 arteries in the VA and 3 arteries in the SA. In the RT group, stenotic arteries from ICA were more common than ECA(36.6% vs 17.1%,p=0.03). In the control group, stenotic arteries from ICA(45.8%) were more common than CCA, ECA and MCA(12.0%,4.8%,8.4%,p<0.001). And VA was more common involved than SA in the control group(p<0.001). Intracranial arteries were more common involved in the control group(21.7% vs 7.3%, p=0.045). The degree of stenosis was similar in both groups. In the RT group, 38 arteries(92.7%) exhibited over 50% stenosis and 9 arteries(22.0%) were subtotal or total occlusive(≥90%). The mean length of all stenotic lesions in the RT group was longer than the control group(24.25±27.46 vs 10.33±6.12,p=0.017). The mean length of VA in the RT group was also longer, as well as the mean length of the anterior circulation(28.78±31.25 vs 11.59±6.2,p=0.039). The mean length of pathological arteries in the posterior circulation of the RT group was longer, but the difference was not significant(15.71±16.64 vs 8.13±5.60, p=0.070). Unilateral stenosis of ICA was more common in the RT group(75.0% vs 27.3%, ?2=7.174, p=0.007). Ulcer plaques at ICA were more common in the RT group(80.0% vs 28.9%, ?2=11.411, p=0.001). Ulcer plaques at VA were also more common in the RT group(100.0% vs 28.6%,?2=8.089, p=0.004). Ulcer plaques of all the pathological vessels were also more common in the RT group(80.5% vs 28.9%, ?2=29.388,p<0.001).4) Nine of the 17 patients from the RT group and all patients in the control group received angioplasty and stenting. The technical success rate was 100% in both groups and no complications were encountered during periprocedural period. Altogether, 17 stents were implanted in the RT group, including 4 stents in the CCA, 7 in the ICA, 4 in the VA, and 2 in the SA. In the control group, 37 stents were implanted, including 25 stents in the ICA, 10 in the VA, and 2 in the SA. Stenting of the ICA tended to be more common in the control group(?2=3.360, p=0.067), and stenting of the CCA only occurred in the RT group.5) The NIHSS score at admission and at discharge was not significantly different between both groups(p=0.929, p=0.732). There was also no significant difference of the m RS score at 3 months and 12 months after discharge in both groups(p=0.306, p=0.724). At discharge, the NIHSS score was significantly improved in RT group(2.06±1.749 vs 3.76±3.27,p=0.003) and in the control group(2.31±2.795 vs 3.86±3.79,p(27)0.001). Compared with the m RS score at 3 months after discharge, the m RS score at 1 year was significantly decreased in the RT group(0.94±1.029 vs 1.06±1.144, p(27)0.001) and in the control group(0.97±0.857 vs 1.26±0.919, p(27)0.001). There was no in-stent restenosis at about one year after discharge in both groups.Conclusions:1) Symptomatic RICAS mainly occurred in patients with a history of RT for head and neck malignances, with the interval of over ten years.2) Symptomatic RICAS mainly involved ICA and CCA from the anterior circulation;VA and SA from the posterior circulation were also affected. It mainly affected extracranial and unilateral arteries, which was consist with the radiation field. Intracranial cerebral artery stenosis after RT was relatively rare.3) Compared with atherosclerotic stenosis without a history of RT, RICAS was longer and ulcer plaques were more common. RICAS may be safely and effectively treated with the angioplasty and stenting procedure. |
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