Single center outcomes of carotid artery stenting in veterans with prior head and neck cancer

Abstract Objective (s): Patients meeting criteria for intervention of carotid stenosis with a history of prior cervical radiation or neck dissection are considered "high risk" for carotid; endarterectomy (CEA). This is a well-established indication for carotid artery stenting (CAS).The long-term outcomes of CAS in this population are less frequently published in the literature but are poor. The purpose of this study was to review long-term results of CAS in veteran patients with a prior history of treatment for head and/or neck cancer. Methods This is a retrospective review of a veteran patient population from 1998-2016.All patients at our institution with a prior history of treatment of head and/or neck cancer who underwent CAS were included in the analysis. During this time period, 44 patients met inclusion criteria and were treated with 57 carotid stenting interventions. Kaplan-Meier analysis was used to determine survival and primary patency. The secondary aims were to analyze early outcomes and to identify predictive risk factors for mortality and reintervention. Results The mean follow-up was 42.9±36.6 months. The cumulative survival at 1, 5 and 10 years was 91%, 67% and 48%, respectively. The primary patency at 1, 5 and 10 years was 95%, 86% and 86% respectively. The reintervention rate was 11% (n=6) with an assisted primary patency rate of 100%. No neurologic events occurred at 30-days. There were 3 strokes in late follow-up and no stroke-related deaths. Eighteen patients (41%) died during the follow-up period, 15 of whom died during the first 5 years of follow-up. Ten (66%) of those patients died of recurrent or active index cancer. On univariate analysis, TNM stage IV was significantly associated with death (P = 0.02). Multivariate models were not statistically significant for predicting mortality or reintervention Conclusions Based on the results in this series, CAS can be performed in these patients with low long-term rates of neurologic events and need for reintervention. However, the survival of patients with head and neck cancer undergoing CAS in this cohort is poor, consistent with other published series of patients undergoing CAS for head/neck cancer with at least 5-year follow-up. In this specific patient population, a more critical analysis of the patient’s overall prognosis, especially as relates to cancer, should be undertaken prior to offering CAS.