https://www.jvascsurg.org/article/S0741-5214(11)01635-1/pdf

Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease

PURPOSE: To estimate the risk of ischemic stroke in patients irradiated for head and neck tumors. PATIENTS AND METHODS: The incidence of ischemic stroke was determined in 367 patients with head and...

Increased Risk of Ischemic Stroke After Radiotherapy on the Neck in Patients Younger Than 60 Years

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 radi...

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy: A Review

Background: Carotid stenosis is a recognized complication of external irradiation to the head and neck for malignancy. This study aim to investigate the pattern and prevalence of radiation induced carotid disease, and to identify risk factors associated with significant stenosis.

Methods: In a comparative cross-sectional study, carotid arteries color flow duplex scan was performed on 240 patients who had received external irradiation to the head and neck area, with a mean interval of 72 months from radiotherapy. They consisted of 181 men and 59 women, with a mean age of 59 years. Fifteen patients had a history of cerebrovascular symptoms.

Results: Internal carotid artery (ICA) stenosis of 70% or greater was detected in 29 arteries in 24 patients. Common carotid artery (CCA) disease of ≥70% was present in 13 arteries in 12 patients. Overall 28 patients had significant ICA/CCA disease (11.7%). Patients with nasopharyngeal and laryngeal carcinoma had more cerebrovascular symptoms, and more frequent CCA stenosis. Significant ICA/CCA stenosis was associated with age, smoking, coronary heart disease, stroke, no head and neck surgery, time interval from radiotherapy, and the site of primary tumor. On logistic regression analysis age (>60 years), cerebrovascular symptoms, interval from irradiation (>5 years), and nasopharynx and larynx cancer were found to be independent significant (P <0.05) predictors of 70% or greater ICA/CCA stenosis.

Conclusions: Patients who had received radiotherapy to the head and neck have a high risk of developing significant carotid stenosis. Routine duplex ultrasound screening in these patients is indicated.

Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies

Acute and long-term toxicity following radiotherapy alone or in combination with chemotherapy for locally advanced cervical cancer

Radiation-induced carotid artery disease following high-dose (greater than 50-Gy) radiotherapy for head and neck cancer may become more common as improved treatment results in longer survival. Duplex ultrasound scans were obtained in 91 consecutive patients to determine whether increased incidence and severity of extracranial carotid disease correlate with prior radiotherapy. Fifty-three patients who underwent radiotherapy an average of 28 months previously and 38 patients who received no radiotherapy were studied. Thirty percent of the irradiated group had lesions of the carotid arteries that were either moderate or severe vs only 6% of the control patients. Five patients were symptomatic; all had undergone radiotherapy. Long-term follow-up with sequential duplex ultrasound examinations is indicated in patients receiving high-dose radiotherapy for head and neck tumors, to detect radiation-induced carotid artery disease and prevent late sequelae.

John R. Jacobs

Papers

Duplex imaging and incidence of carotid radiation injury after high-dose radiotherapy for tumors of the head and neck.