Carotid artery stenosis in patients who have undergone radiation therapy for head and neck malignancy.

Abstract

Although it is established that small and medium sized arteries undergo extensive radiation damage, the effect on large vessels such as the carotid arteries is less well understood. We sought to determine if an increased severity of carotid artery stenosis is present in patients who have undergone radiotherapy for head and neck tumours. 45 patients aged 43-90 years (average 67) with head and neck malignancies treated with radiotherapy underwent colour Doppler ultrasonographic scanning of the carotid arteries. These patients were compared with a population of asymptomatic historical controls. 60% of patients demonstrated stenosis ranging from 21 to 86%. 38% of patients demonstrated a stenosis greater than or equal to 50%. Carotid artery stenosis appears to be increased in patients who have previously undergone treatment with radiotherapy to the head and neck regions compared with controls (p < 0.001). These findings suggest that radiation has an adverse effect on large vessels. Colour Doppler follow-up may be indicated for patients receiving head and neck radiation therapy.

Outcomes of carotid stenting in patients with previous neck radiation

“…The safety and efficacy of carotid stenting in significant obstructive lesions of the ICA have been investigated in several large studies [22][23][24][25][26][27][28]. The CREST study is the most recent randomized controlled study to show similar short-and long-term outcomes with stenting compared to carotid endarterectomy [28].…”

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

“…The mean velocity increase was significantly higher in the XRT group (19% versus 1%, PϽ0.05). Dubec et al 45 screened 45 patients after a minimum of 5 years after XRT and observed a Ͼ50% stenosis of either the ICA or CCA in 17 patients (38%). They noted an expected prevalence of 4% of such stenosis in asymptomatic disease, but this was drawn from unmatched historical data.…”

Stenting in the Remnant of the Third Aortic Arch in a Case of Post-Irradiation Occluded Internal Carotid Artery

“…Bilateral anterior cerebral arteries, middle cerebral arteries and the vertebro-basilar system were within normal limits. the patient was premedicated with aspirin and plavix, and systemic heparinization and neck region 5,6 . routine doppler ultrasound or Cta for screening is recommended after radiotherapy 1 .…”