A Prospective Study of the Effects of Irradiation on the Carotid Artery

Muzaffar, Kamil; Collins, Sharon L.; Labropoulos, Nicos; Baker, William H.

doi:10.1097/00005537-200011000-00007

Cited by 95 publications

(73 citation statements)

References 15 publications

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“…161 This increase in the thickness of the intima and media of the carotid artery is associated with an increased risk of stroke. 162 Preexisting atherosclerosis at time of treatment may be an exacerbating factor.…”

Section: Carotid Artery Diseasementioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

503

436

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Section: Carotid Artery Diseasementioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

503

436

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“…As the first of only 2 genuinely prospective imaging studies on this problem, Muzzafar et al 41 followed up 36 head and neck cancer patients after XRT. There was a 0.17-mm IMT increase (for the right and left CCA/ICA) at 1 year and a further 0.06-mm (left CCA/ICA) to 0.16-mm (right CCA/ ICA) increase in the subsequent year in a subset of 12 patients, 21 times the rate suggested by age-and sex-matched population data.…”

Section: Head and Neck Xrtmentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

229

180

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Background and Purpose-Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined. Methods-We examined studies on the epidemiology, imaging, pathogenesis, and management of medium-and large-artery intra-and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized. Results-The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy.Chronic radiation vasculopathy affecting medium and large intra-and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Conclusions-Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke.Evidence-based guidelines for the management of asymptomatic and symptomatic (medium-and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival. (Stroke. 2011;42:2410-2418.)

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“…4 Retrospective studies in head and neck cancer patients have identified stenosis and reduced blood flow or increased intimamedia thickness of the irradiated section of the carotid artery. [5][6][7][8][9] A cohort study of 367 head and neck cancer patients irradiated at the Netherlands Cancer Institute also showed a significantly increased risk of ischemic stroke in a relatively young population that would not normally be associated with atherosclerosis. 10 The overall RR of stroke in the patient cohort was 5.6 times that expected, and this increased to 10.1 after a follow-up of Ͼ10 years.…”

mentioning

confidence: 99%

Ionizing Radiation Accelerates the Development of Atherosclerotic Lesions in ApoE−/− Mice and Predisposes to an Inflammatory Plaque Phenotype Prone to Hemorrhage

Stewart

Heeneman

Poele

et al. 2006

The American Journal of Pathology

250

160

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After radiotherapy treatment, there is an increased incidence of localized atherosclerosis in patients with Hodgkin's disease, breast cancer, and head and neck cancer. Here, we established a mouse model to study the development and progression of radiation-induced atherosclerosis and to compare the phenotype of these lesions with age-related atherosclerosis. Atherosclerosis-prone ApoE ؊/؊ mice fed a regular chow diet received single radiation doses of 14 Gy or sham treatments (0 Gy) to the neck, including both carotid arteries. At 22, 28, and 34 weeks after irradiation, blood samples were taken, and the arterial tree was removed for histological examination. Cholesterol levels in irradiated mice were not significantly different from agematched controls, and markers of systemic inflammation (soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, and C-reactive protein) were not elevated. Earlier diagnosis and better treatment options have lead to improvements in cancer-specific survival for most tumor types, but this also results in an increased number of patients at risk for developing treatment-related side effects. At least one-half of all cancer survivors will have received radiotherapy during their treatment, and vascular injury is the major cause of late radiation morbidity.A meta-analysis of radiotherapy trials for women with early breast cancer showed that the benefit of radiotherapy (5% reduction in cancer related deaths) was offset by a 4% increase in non-breast-cancer-related mortality, mainly late vascular disease that became apparent with longer follow-up.

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A Prospective Study of the Effects of Irradiation on the Carotid Artery

Cited by 95 publications

References 15 publications

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Ionizing Radiation Accelerates the Development of Atherosclerotic Lesions in ApoE−/− Mice and Predisposes to an Inflammatory Plaque Phenotype Prone to Hemorrhage

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