Assessing radiation-induced carotid vasculopathy using ultrasound after unilateral irradiation: a cross-sectional study

Abstract

Background Increased head and neck cancer (HNC) survival requires attention to long-term treatment sequelae. Irradiated HNC survivors have a higher ischemic stroke risk. However, the pathophysiology of radiation-induced vasculopathy is unclear. Arterial stiffness could be a biomarker. This study examined alterations in intima-media thickness (IMT) and stiffness-related parameters, shear wave (SWV) and pulse wave velocity (PWV), in irradiated compared to control carotids in unilateral irradiated patients. Methods Twenty-six patients, median 40.5 years, 5–15 years after unilateral irradiation for head and neck neoplasms underwent a bilateral carotid ultrasound using an Aixplorer system with SL18-5 and SL10-2 probes. IMT, SWV, and PWV were assessed in the proximal, mid, and distal common (CCA) and internal carotid artery (ICA). Plaques were characterized with magnetic resonance imaging. Measurements were compared between irradiated and control sides, and radiation dose effects were explored. Results CCA-IMT was higher in irradiated than control carotids (0.54 [0.50–0.61] vs. 0.50 [0.44–0.54] mm, p = 0.001). For stiffness, only anterior mid-CCA and posterior ICA SWV were significantly higher in the irradiated side. A radiation dose–effect was only (weakly) apparent for PWV (R2: end-systolic = 0.067, begin-systolic = 0.155). Ultrasound measurements had good–excellent intra- and interobserver reproducibility. Plaques had similar characteristics but were more diffuse in the irradiated side. Conclusions Increased CCA-IMT and SWV in some segments were seen in irradiated carotids. These alterations, even in young patients, mark the need for surveillance of radiation-induced vasculopathy. Trial registration: clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04257968).

Stroke Risk in Survivors of Head and Neck Cancer

“…This observation is in line with previous reports of high stroke risk in younger survivors of HNC. 4 , 7 , 8 , 22 While the exact mechanism of this differential association of age with stroke is largely unknown, it is possible that complications from HNC treatments, including cisplatin-induced vascular toxic effects 23 and radiation-induced carotid artery pathologies, 24 , 25 , 26 , 27 pose a significant stroke risk in younger individuals. Moreover, it is widely believed that young age of exposure to cancer treatment is an important risk factor for later complications.…”

Longitudinal Changes in the Carotid Arteries of Head and Neck Cancer Patients Following Radiation Therapy: Results from a Prospective Serial Imaging Biomarker Characterization Study

“…RT has been shown to be associated with early morphologic vascular changes, such as increased IMT, and vascular physiologic changes, such as altered arterial elasticity. 6 A recent systematic review by Randolph et al identified a total of 8 studies published after 2010, 4 of which were prospective, that evaluated carotid IMT change after RT. 24 All 8 studies showed significant increases in carotid IMT after neck irradiation.…”

“…Other than the early morphologic vascular changes, RT has also been associated with vascular physiologic changes, including altered arterial elasticity. 6 Although altered vascular elasticity is difficult to assess clinically, previous studies have shown a good correlation between traditionally measured vascular elasticity parameters and vascular strain and have proposed the use of vascular strain for the assessment of carotid artery elasticity. 15,16 Changes in carotid vascular tissue deformation (strain) after RT have not been well studied.…”

“…RT has been shown to be associated with morphologic changes in the carotid artery, in the form of increased wall thickness and accelerated atherosclerosis. 6 Carotid intimal-medial thickness (IMT) is a measurement of the thickness of the artery wall using B-mode ultrasound.…”

“…RT has been shown to be associated with morphologic changes in the carotid artery, in the form of increased wall thickness and accelerated atherosclerosis. 6 Carotid intimal-medial thickness (IMT) is a measurement of the thickness of the artery wall using B-mode ultrasound. Increased common carotid artery (CCA) IMT is an early marker of atherosclerosis and a strong predictor of future vascular events in the general population.…”