Neck irradiation, carotid injury and its consequences

Abayomi, Olubunmi K.

doi:10.1016/j.oraloncology.2003.12.005

Cited by 95 publications

(57 citation statements)

References 72 publications

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“…In addition, external beam radiation accelerates atheromatous changes in arteries. 58 It is therefore not surprising that manipulation of these diseased vascular structures could result in plaque rupture, embolism, and vasospasm. 59 -61 Other procedures that potentially compromise cerebral perfusion may also increase the risk of stroke.…”

Section: Type Of Surgerymentioning

confidence: 99%

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

2011

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Perioperative stroke after noncardiac, nonneurosurgical procedures is more common than generally acknowledged. It is reported to have an incidence of 0.05-7% of patients. Most are thrombotic in origin and are noted after discharge from the postanesthetic care unit. Common predisposing factors include age, a previous stroke, atrial fibrillation, and vascular and metabolic diseases. The mortality is more than two times greater than in strokes occurring outside the hospital. Delayed diagnosis and a synergistic interaction between the inflammatory changes normally associated with stroke, and those normally occurring after surgery, may explain this increase.Intraoperative hypotension is an infrequent direct cause of stroke. Hypotension will augment the injury produced by embolism or other causes, and this may be especially important in the postoperative period, during which monitoring is not nearly as attentive as in the operating room. Increased awareness and management of predisposing risk factors with early detection should result in improved outcomes. STROKE is an important cause of morbidity and mortality, particularly in patients more than 65 yr old. In cardiac, neurologic, and carotid surgery, the incidence is known to be high (2.2-5.2%).1 However, little is known regarding perioperative stroke following other types of surgery including general, urologic, orthopedic, thoracic, and gynecologic procedures. The aims of this article are to review the incidence, pathophysiology, risk factors, and outcomes associated with perioperative stroke following noncardiac, nonneurologic, and vascular surgery. Suggestions regarding the timing of elective surgery after stroke and ways in which one can reduce the incidence and improve outcomes are also outlined. DefinitionThe World Health Organization definition of stroke is a "focal or global neurologic deficit of cerebrovascular cause that persists beyond 24 h or is interrupted by death within 24 h." Transient ischemic attack is acute loss of focal cerebral or ocular function with symptoms lasting less than 24 h and is usually presumed to be embolic or thrombotic in origin. In addition, a third type of cerebrovascular event has recently attracted much attention in the nonsurgical setting. Covert stroke is an asymptomatic ischemic event usually only detected by advanced neuroimaging techniques, such as diffusion-weighted magnetic resonance imaging sequences.2 Although the diagnosis is often missed at the time of the event, covert stroke has been associated with an adverse effect on cognitive function and quality of life. Currently other than in cardiac and carotid artery surgery, there is no study evaluating the incidence, impact, and risk factors of covert stroke in the general surgical population.

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Section: Type Of Surgerymentioning

confidence: 99%

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

2011

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“…However, it is of great significance to maintain the balance between the risk of developing carotid stenosis and the benefits of RT for the treatment of head and neck malignancies [22,23]. RT should be carried out in order to enhance treatment effectiveness and protect the adjacent normal tissues.…”

Section: Follow-up and Prevention Strategiesmentioning

confidence: 99%

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

Cao

2013

Intervent Neurol

102

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In recent decades, with the improvement of radiotherapy (RT) technology and comprehensive treatment, the survival rate of head and neck malignancies has gained remarkable progress. Vascular injury and subsequent carotid stenosis following RT, as the backbone of treatment, have received increasing attention. Many investigations have demonstrated that radiation can result in the increase in carotid intima-media thickness, carotid stenosis and consequently lead to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. In this review, we will examine the incidence of radiation-induced carotid artery stenosis, its morphological and histological characteristics, as well as its pathogenesis. The treatment and prevention methods, including follow-up strategies, will also be discussed at the end of the present review.

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“…This has led to an increased prevalence of late side effects such as carotid artery stenosis. 1 While in previous studies the incidence of carotid artery stenosis after treatment was between 12%-30%, this rate increased to 50% with the prolongation of the survival. 2 The effect of ionizing RT on small and medium size vessels is well known since 1940s.…”

Section: Introductionmentioning

confidence: 93%

“…In order to decrease this sequela of head and neck irradiation, it is important to treat hypertension and diabetes seriously and provide consultation for obesity and smoking. 1 RT applied in the treatment of head and neck carcinomas frequently leads to iatrogenic hypothyroidism. Hypothyroidism due to RT was first reported in 1960s.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Late Radiation Side Effects in Nasopharyngeal Cancer Patients

Mayadağlı¹

2012

UHOD

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The prolongation of survival in cases with nasopharynx cancer has made quality of life after treatment more important. The aim of this study is to consider late toxicity developing after treatment in order to maintain a high quality of life. Thirty-two patients receiving radiotherapy (RT) to the neck region 1-10 years ago due to nasopharyngeal carcinoma were included in the study. Neck ultrasonography (USG), thyroid function tests and dynamic brain magnetic resonance imaging (MRI) were carried out for carotid artery stenosis, hypothyroidism, and necrosis of the temporal lobe. Obtained data were analyzed with the SPSS 11.5. Intima-media thickness of below 60 Gy and above 60 Gy doses administered to the neck were similar. Intima-media thickness was greater in patients with a period longer than 5 years after RT than with a period shorter than 5 years (p< 0.001). Intima-media thicknesses of the patients above 40 years, with high cholesterol values, a history of smoking and hypertension were higher than those without them (p< 0.001). There was hypothyroidism in five (15%) of the 32 patients. Necrosis of the temporal lobe was not seen in any of the patients. Carotid artery stenosis after treatment depends more on the duration of the period after treatment and the patient's being in the age group when atherosclerotic risk factors are present than on the amount of dose administered.Keywords: Head-neck tumor, Radiotherapy, Late toxicity, Hypothyroidism ÖZET Nazofarenks kanserli Olgularda Rdyoterapiye Sekonder Geliflen Geç Yan Etkilerin De¤erlendirilmesiSon y›llarda nazofarenks kanserli olgularda yaflam süresinin artmas›, tedavi sonras› yaflam kalitesini ön plana ç›karm›flt›r. Bu grup hastalarda yaflam kalitesini yüksek tutmak için tedavi sonras› geliflen geç toksisitelerin irdelenmesi amaçlanm›flt›r. Nazofarenks kanseri nedeniyle boyun bölgesine 1-10 y›l önce radyoterapi (RT) alan 32 hasta çal›flmaya al›nm›flt›r. Hastalar›n karotis arter stenozu, hipotiroidi ve temporal lob nekrozu için boyun ultrasonogrofi (USG), tiroid fonksiyon testi ve dinamik beyin magnetik rezonans› (MR) yap›l-m›flt›r. Elde edilen veriler SPSS 11.5'de de¤erlendirilmifltir. Boyuna uygulanan 60 Gy alt› ile 60 Gy üzeri dozlardaki karotis intima-media kal›nl›¤› benzer ç›km›flt›r. RT sonras› geçen süre 5 y›ldan fazla olan hastalarda intima-media kal›nl›¤›, 5 y›ldan az olan hastalara oranla daha yüksek saptanm›flt›r (p< 0.001). 40 yafl üstü, kolesterol de¤eri yüksek, sigara ve hipertansiyon hikayesi olan hastalar›n damar kal›nl›¤› olmayanlardan daha yüksek ç›km›flt›r (p< 0.001). 32 hastadan 5'inde (%15) hipotiroidi saptanm›flt›r. Hastalar›n hiçbi-rinde temporal lob nekrozuna rastlanmam›flt›r. Tedavi sonras› karotis arter stenozu, uygulanan dozdan çok tedavi sonras› geçen sü-reye ve hastan›n aterosklerotik risk faktörlerini tafl›yaca¤› yafl grubunda olmas›na ba¤l›d›r. Bu grup hastalar›n takip ve kontrollerinde geç toksisitenin iyi flekilde de¤erlendirilmesi, aterosklerotik risk faktörlerine yönelik önleyici tedbirlerin al›nmas› ve tedavisine yönel...

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Neck irradiation, carotid injury and its consequences

Cited by 95 publications

References 72 publications

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

Perioperative Stroke in Noncardiac, Nonneurosurgical Surgery

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

Evaluation of Late Radiation Side Effects in Nasopharyngeal Cancer Patients

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