Carotid artery repair for radiation-associated atherosclerosis is a safe and durable procedure

Objective: The development of carotid atherosclerosis after neck irradiatio n is well documented. There has been concern about the safety and durabilit y of carotid artery repair through a radiated field. The objective of this report is to describe the immediate and long-term results of a series of ca ses collected in a 13-year interval. Methods: From 1984 to 1997, 24 patients underwent 26 carotid artery operati ons. All the patients had undergone prior radiation therapy at a mean inter val of 17 years, with an average radiation dose of 6300 rad. Severe scarrin g of the skin or radiation fibrosis were present in two thirds of the patie nts, with 4 patients having permanent tracheostomies. The indications for c arotid surgery included cerebral or monocular transient ischemic attack (58 %), asymptomatic high-grade stenosis (27%), prior stroke (12%), and tumor i nvasion of the carotid artery (4%). General anesthesia was used with select ive shunting on the basis of carotid artery back pressure or electroencepha lography monitoring. patch angioplasty closure was used in 79% of the patie nts. The operations included standard carotid endarterectomy (n = 20), exte rnal carotid endarterectomy (n = 2), carotid patch angioplasty alone (n = 2 ), aortocarotid bypass grafting (n = 1), and carotid interposition grafting (n = I). Four patients required skin grafting or myocutaneous flaps. Results: No deaths or strokes occurred within 30 days of the operations. Si x patients had transient cranial nerve palsy, and two had wound infections. The patients were followed from 1 to 156 months, with six patients being f ollowed for longer than 18 months. No strokes were seen at late follow-up e xamination. Duplex scan examination documented one occlusion, in a patient with primary closure, and two restenoses, one of which necessitated reopera tion. The remainder of the grafts were widely patent. Conclusions: Carotid surgery after neck irradiation is safe and durable. Th e long-term patency rates and the protection against subsequent neurologic events are similar to the results obtained in the absence of radiation ther apy Problems of wound healing were not found in this series.