Carotid Artery Occlusive Disease Following External Cervical Irradiation

Levinson, Stuart A.; Close, Myron B.; Ehrenfeld, William K.; Stoney, Ronald J.

doi:10.1001/archsurg.1973.01350210031010

Cited by 94 publications

(22 citation statements)

References 7 publications

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“…It is this periadventitial scarring, often combined with advanced atheroma of the endothelium, that is most commonly described in surgical case series. 7,56,57,62 Documentation of disease evolution in the manner of Fonkalsrud et al 55 in humans is clearly impossible, but Zidar et al 59 described an autopsy case of a 35-year-old-man who succumbed to metastatic tonsillar carcinoma 20 months after XRT. Extensive focal inflammation and necrosis of the vasa vasorum and adventitium were seen.…”

Section: Pathogenesismentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

228

180

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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 radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates. Conclusions-Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke.Evidence-based guidelines for the management of asymptomatic and symptomatic (medium-and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival. (Stroke. 2011;42:2410-2418.)

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Section: Pathogenesismentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

228

180

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“…4,5 Although the extracranial carotid arteries are always included in the radiation port for this type of cancer, the factors responsible for the late effect of radiation on these large vessels have not been adequately defined. [6][7][8][9][10][11][12] Carotid endarterectomy has been shown in several recent large-scale studies to be efficacious for stroke prevention. 13,14 Although the natural history of radiationinduced CAS remains uncertain, the recent guideline for carotid endarterectomy to prevent stroke is based on the severity of carotid stenosis and not the etiology.…”

mentioning

confidence: 99%

Predictors of carotid artery stenosis after radiotherapy for head and neck cancers

Chang

Lee

et al. 2009

Journal of Vascular Surgery

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“…A review of the literature on radiationinduced carotid artery disease disclosed that the interval from radiation to the onset of cerebrovascular attacks ranged from one and a half to thirty years with a total radiation dose to the cervical field of 41 to 120 Gy.6-9,12-14 Bilateral carotid artery narrowing and/or occlusion due to radiation has been reported in 11 patients including ours, 6,8,9,[12][13][14] although the extent and severity of the carotid artery involvement depended on the radiation dose and the size of the radiation field.…”

Section: Discussionmentioning

confidence: 81%

Bilateral Internal Carotid Artery Disease Secondary to Cervical Radiation

Horimoto

Kodama

1996

Angiology

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A patient with radiation-induced bilateral carotid artery disease is presented. A fifty-six-year-old man was admitted to hospital for evaluation of recurrent transient ischemic attacks. He had received cervical radiation for pharyngeal squamous cell carcinoma five years earlier. The radiation was directed at the cervical fields bilaterally and the anterior cervical field using x-rays for a total of 120 Gy. Computed tomography of the brain obtained at admission revealed a low-density area in the right parietal lobe. Carotid arteriograms revealed a completely occluded right internal carotid artery and a severely narrowed left internal carotid artery. There was good collateral supply from the posterior communicating arteries to the internal carotid arteries, bilaterally. The patient was medically treated with anticoagulant and antiplatelet therapy and has been free of subsequent cerebral ischemic attacks.

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Carotid Artery Occlusive Disease Following External Cervical Irradiation

Cited by 94 publications

References 7 publications

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Predictors of carotid artery stenosis after radiotherapy for head and neck cancers

Bilateral Internal Carotid Artery Disease Secondary to Cervical Radiation

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