Abstract Number: Esoc2026lt60 Surgical Versus Endovascular Revascularization in Radiation-Induced Carotid Artery Stenosis: The Crics Prospective Cohort Study

Abstract Background and aims Radiation-induced carotid stenosis (RICS) is a known sequela of head and neck irradiation that increases stroke risk, and optimal revascularization strategy remains unclear. The Carotid Revascularization for Radiation-Induced Carotid Artery Stenosis (CRICS) cohort was designed to compare outcomes of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) in patients with RICS. Methods We performed a prospective multicenter cohort study of patients with RICS undergoing CEA or CAS. All patients were followed for 12 months with clinical and imaging evaluations. The primary outcome was ≥50% carotid restenosis at 12 months. Secondary outcomes included periprocedural stroke, myocardial infarction (MI), death, wound complications, and cranial nerve injury (CNI). Univariable and multivariable Cox regression was used to identify independent predictors of restenosis. Results Ninety-two patients (49 CEA, 43 CAS) were enrolled. At 12 months, restenosis was significantly more frequent after CAS (28.0%) than after CEA (4.1%; P = 0.003). Procedure type (CAS vs CEA) was the only independent predictor of restenosis on Cox analysis (hazard ratio 6.69, 95% CI 1.44–98.95; P = 0.015). Rates of stroke, death, and MI did not differ significantly between groups. No wound complications occurred. CNI occurred only in the CEA group (transient in 12.4%, persistent in 4.1%). Conclusions In RICS, CEA performed in experienced centers was associated with a significantly lower risk of 12-month restenosis than CAS, with no differences in stroke or death outcomes. CEA should be considered the preferred revascularization approach in suitable patients, while its CNI risk must be weighed against CAS’s restenosis risk. Conflict of interest