OBJECTIVES: Presentation of radiation-induced lesions in carotid arteries of patients with head and neck squamous cell carcinoma (HNSCC) and the evaluation of the effectiveness of endovascular treatment of symptomatic stenoses. MATERIALS AND METHODS: We retrospectively analyzed 26 patients who underwent surgery and subsequently cervical radiotherapy (RT) for HNSCC, focusing on radiation-induced vascular disease in neck arteries—from the latency period to the occurrence of neurological events—and the endovascular treatment of the internal carotid artery (ICA) and/or of common carotid artery (CCA) stenoses. The vascular lesions were diagnosed with Doppler ultrasonography and selective digital angiography. Patients with >70% stenoses of ICA and/or CCA were scheduled for carotid artery stenting (CAS). They were followed-up with neurological examinations and Doppler ultrasonography at 6, 12, and 24 months after stenting. RESULTS: Radiation-induced vascular diseases occurred in the ICA in 22 patients (85%), CCA in 15 (58%), and in ECA in 15 (58%). The stents were implanted in 25 ICA and 17 CCA. Thirteen patients (50%) had one stent, eight (30%) had two stents, four (15%) had three stents, and one patient had five stents. Overall, 46 stents were implanted. Technical success was achieved in all patients. No cerebrovascular events occurred in the 24-months follow-up. CONCLUSION: RT in patients with HNSCC holds a significant risk factor of developing carotid artery stenosis and cerebrovascular events. Carotid stenting is preferable mode of treatment for radiation-induced stenosis. A screening program with doppler ultrasonography enables pre-stroke detection of carotid stenosis.

No abstract

SummaryArteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.

Introduction: Natural killer cells (NK cells) present a unique ability to recognize and kill cells infected with a variety of pathogens, regardless of prior immunization. Natural killer T-like cells (NKT Aim of the study was to estimate the impact of splenectomy on postoperative quantitative changes of NK cells (CD3-/CD16+CD56+) and NKT-like cells (CD3+/CD16+CD56+) as two important lymphocyte subsets involved in host defence against various pathogens. Material and methods: Assessment of NK and NKT-like cells was performed by the flow cytometry in a group of 100 splenectomised patients and 20 healthy volunteers. Results: Patients with secondary asplenia displayed a decreased ratio of NK cells (CD3-/ CD16+CD56+) (p = 0.012) and a higher ratio of NKT-like cells (CD3+/CD16+CD56+) (p = 0.001) in comparison to controls. Patients who underwent elective splenectomy presented a higher amount of NK cells (CD3-/CD16+CD56+) than those with post-traumatic spleen removal (p = 0.035). The time since surgery negatively correlated with NK cells counts (CD3-/CD16+CD56+). In those patients who noticed increased susceptibility to infections, NK cells number (CD3-/CD16+CD56+) was lower (p = = 0.007) than in those patients who did not observe any change in prevalence of infections. Moreover, those patients who noticed an increased infection rate had higher frequencies of NKT-like cells (CD3-/ CD16+CD56+) comparing to those who did not observe any change in the prevalence of infections (p = 0.006). Conclusions: This study provides a further piece of information on the complex immune disturbances in splenectomised individuals leading to the increased risk of bacterial infections. Results obtained suggest that monitoring of NK and NKT-like cells number may provide useful information for determining asplenia-related immunosuppression.

No abstract