Relationship between histologic features and outcomes of carotid revascularization for radiation-induced stenosis

Sano, Noritaka; Satow, Tetsu; Maruyama, Daisuke; Kataoka, Hiroharu; Morita, Ken Ichi; Ishibashi‐Ueda, Hatsue; Iihara, Koji

doi:10.1016/j.jvs.2015.03.021

Cited by 32 publications

(21 citation statements)

References 30 publications

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“…The length of radiation induced stenosis segment has not been commonly evaluated. Sano N et al showed that stenosis lengths in CCA were significantly longer in the radiation induced stenosis group then in the non-irradiated patients with atherosclerotic stenosis (32.8 +/− 30.0 mm vs 6.9 +/− 5.1 mm) [20]. This is close to the values found in our study, where the mean length of CCA stenosis was 31.16 +/− 10.60 mm.…”

Section: Discussionsupporting

confidence: 90%

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

Trojanowski

Sojka

Trojanowska

et al. 2019

Translational Oncology

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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.

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Section: Discussionsupporting

confidence: 90%

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

Trojanowski

Sojka

Trojanowska

et al. 2019

Translational Oncology

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“… 19 Occurrences of transient ischemic attacks or ischemic stroke have been well-documented due to the atherosclerotic changes observed in the irradiated vessels. 20 The main mechanisms of radiation-induced CAS include direct damage to the vessel, accelerated atherosclerosis, intimal proliferation, necrosis of the media, and peri-adventitial fibrosis. 21 , 22 Radiation-induced plaque and arterial wall thickening, which is histologically comparable with spontaneous atherosclerosis, tends to develop in the radiotherapy fields and can even occur in the cohort without the other risk factors of atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Simulation Study of Carotid Artery and Pharyngeal Constrictor Muscle Sparing-Radiotherapy in Glottic Carcinoma

Özdemir

Acibuci

Selek

et al. 2020

Technol Cancer Res Treat

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Background: This preliminary simulation study aimed to compare the dosimetric outcomes of carotid arteries (CAs) and pharyngeal constrictor muscle (PCM) in patients with T1N0M0 glottic carcinoma undergoing helical tomotherapy-intensity modulated radiotherapy (HT-IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) plans. Methods: In addition to the clinical target volume (CTV) which was defined as the entire larynx, the CAs and PCM of 11 glottic carcinoma patients were delineated. The CTV was uniformly expanded 5 mm to create a planning target volume (PTV) relative to the PCM and at a distance of 2 mm from the CA. The dosimetric characteristics in HT-IMRT and lateral opposed fields-based 3D-CRT plans were analyzed. Results: Median D95%and V100% of PTV were significantly higher in HT-IMRT (p < 0.001) compared to 3D-CRT. The right/left CA dosimetric outcomes, including the mean doses (20.7/21.5 Gy versus 48.7/50.5 Gy), Dmax (53.6/52.0 Gy versus 67.4/67.7 Gy), V30 (25.0/27.1% versus 77.6/80.3%), V40 (8.0/7.9% versus 74.6/71.9%), and V50 (2.0/1.2% versus 70.0/71.6%) were also significantly lower in HT-IMRT (p < 0.05), similar to the mean PCM doses (49.6 Gy versus 62.6 Gy for 3D-CRT;p < 0.001), respectively. Conclusions: Our present results demonstrated the feasibility of simultaneous sparing of the CAs and PCM in HT-IMRT- compared to 3D-CRT plans in glottic carcinoma patients undergoing definitive radiotherapy.

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“…The exact mechanism for carotid stenosis is not clear 29 . Injury to microvasculature may be the most important mechanism for injury in the large arteries 7 . Further research needs to be conducted in this area.…”

Section: Discussionmentioning

confidence: 99%

“…However, late complications, such as those reported in our previous work (optic neuropathy, brachial plexus injury and brain necrosis) 4 – 6 , have shown an increasing problem for RT treatment of NPC. While commonly used to prevent nodal metastasis, RT contributes to atherosclerosis of the irradiated vessels and increases the risk of vascular stenosis, which may lead to transient ischemic attacks (TIA) or ischemic stroke 7 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy

Zhou

Fan

Zheng

et al. 2018

Sci Rep

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Radiotherapy (RT) serves as the most efficient treatment for nasopharyngeal carcinoma (NPC) and can cause carotid stenosis. This work compared the incidence of significant carotid stenosis between intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2D-RT) for NPC and explored the risk factors. We retrospectively reviewed 233 cases with NPC who underwent carotid ultrasound post IMRT or 2D-RT from 2006 to 2015. The incidence of significant stenosis after RT was 19.3%. Significant stenosis was identified in 20 (14.6%) of 137 patients treated with IMRT and 25 (26.0%) of 96 patients with 2D-RT, respectively (p = 0.035). Multivariate logistic analysis indicated age (odds ratio = 1.054, 95% CI = 1.011–1.099, p = 0.014), radiation technique (IMRT) (odds ratio = 0.471, 95%CI = 0.241–0.919, p = 0.027) and time interval (odds ratio = 1.068, 95%CI = 1.033–1.105, p = 0.001) as independent predictors for significant carotid stenosis. Our study suggests that IMRT was associated with decreased incidence of significant carotid stenosis versus 2D-RT for NPC. Prevention and carotid ultrasound should be considered for older NPC survivors with longer interval from RT, especially those treated with 2D-RT.

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Relationship between histologic features and outcomes of carotid revascularization for radiation-induced stenosis

Abstract: Our radiologic and histologic analyses revealed that advanced RICS is often accompanied by formation of vulnerable plaque. CEA can prevent undesirable late outcomes in such cases.

Cited by 32 publications

References 30 publications

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

Preliminary Simulation Study of Carotid Artery and Pharyngeal Constrictor Muscle Sparing-Radiotherapy in Glottic Carcinoma

Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy

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