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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：虽然头颈部和胸部肿瘤（HNCC）的放射治疗很常见，它可能导致锁骨下动脉（PISSA）的照射后狭窄。经皮腔内血管成形术和支架置入术（PTAS）治疗严重PISSA的疗效尚不清楚。
目的：比较重度PISSA患者（RT组）和未接受放疗患者（非RT组）的PTAS的技术安全性和结局。
方法：在2000年和2021年期间，我们回顾性招募了接受PTAS的锁骨下动脉重度症状性狭窄（>60％）患者。新的椎基底动脉缺血性病变（NRVBIL）的发生率，比较两组患者在术后24小时内经弥散-重量成像(DWI)诊断;症状缓解;长期支架通畅性.
结果：两组61例患者均取得了技术成功。与非RT组(44例,44个病变)，RT组（17例，18个病灶）有较长的狭窄（22.1vs11.1毫米，P=0.003),更多的溃疡性斑块（38.9%vs9.1%，P=0.010),和更多的中段或远端狭窄(44.4%和9.1%，P<0.001)。非RT组和RT组之间的技术安全性和结果为NRVBIL在围手术期脑MRIDWI上的30.0％对23.1％，P=0.727;症状复发率（平均随访67.1±50.0个月）2.3％vs11.8％，P=0.185；支架内再狭窄率显著（>50%）2.3%vs11.1%，P=0.200。
结论：PTAS对PISSA的技术安全性和结果不逊于未接受过辐射的对应物。PISSA的PTAS是治疗患有PISSA的HNCC患者的医学难治性缺血症状的有效方法。
目的：比较重度PISSA患者（RT组）和未接受放疗患者（非RT组）的PTAS的技术安全性和结局。
方法：在2000年和2021年期间，我们回顾性招募了接受PTAS的锁骨下动脉重度症状性狭窄（>60％）患者。新的椎基底动脉缺血性病变（NRVBIL）的发生率，比较两组患者在术后24小时内经弥散-重量成像(DWI)诊断;症状缓解;长期支架通畅性.
结果：两组61例患者均取得了技术成功。与非RT组(44例,44个病变)，RT组（17例，18个病灶）有较长的狭窄（22.1vs11.1毫米，P=0.003),更多的溃疡性斑块（38.9%vs9.1%，P=0.010),和更多的中段或远端狭窄(44.4%和9.1%，P<0.001)。非RT组和RT组之间的技术安全性和结果为NRVBIL在围手术期脑MRIDWI上的30.0％对23.1％，P=0.727;症状复发率（平均随访67.1±50.0个月）2.3％vs11.8％，P=0.185；支架内再狭窄率显著（>50%）2.3%vs11.1%，P=0.200。
结论：PTAS对PISSA的技术安全性和结果不逊于未接受过辐射的对应物。PISSA的PTAS是治疗患有PISSA的HNCC患者的医学难治性缺血症状的有效方法。
