Delayed cerebrovascular consequences of therapeutic radiation.A clinicopathologic study of a stroke associated with radiation-related carotid arteriopathy

Abstract

A young woman, successfully treated for Hodgkin's disease with radiation and MOPP chemotherapy, incurred a devastatiq stroke months after radiation therapy to the neck and other areas. There was no premonitory clinical history of cerebrovascular attacks. Autopsy showed unilateral thrombotic occlusion of the internal carotid artery unassociated with neoplastic or fibrotic annular constriction of the vessel. There was medial thickening and fibroblastic proliferation within the carotid artery. Areas of focal elastic membrane degeneration involved the cervical portions of the carotid. Thrombus was organized to the damaged vessel wall and was propagated into the intracranial vessels. Aneurysm formation and arterial hemorrhages were absent. These vascular changes occurred in an area of extensive radiation (7200 rads). Pathoanatomical studies in this patient indicate that radiation-induced vascular changes were associated with a "delayed" stroke.

Baroreflex Failure as a Late Sequela of Neck Irradiation

“…Histopathologic studies have noted carotid atherosclerotic changes, thickening, and perivascular fibrosis after radiation, with intimal proliferation, hyaline deposition, and elastic layer fragmentation and increased collagen produc-tion, polymorphonuclear cell infiltration, and accumulation of foam cells and fibroblasts. [21][22][23][24][25] Although no analogous histopathologic studies have focused specifically on the carotid sinus region, one might reasonably suspect the same types of changes, which would consequently attenuate afferent baroreceptor traffic in response to perturbations of blood pressure. The finding of carotid atherosclerosis in all 3 patients was consistent with the late development of a selective afferent baroreflex lesion from carotid arterial rigidification.…”

Outcomes of carotid artery stenting versus historical surgical controls for radiation-induced carotid stenosis

“…The ionizing effect of radiation causes arteritis, which may lead to stenosis, thrombosis, fibrosis, or acceleration of atherosclerosis. [1][2][3] Radiationinduced lesions often affect long arterial segments and atypical locations such as the proximal common carotid artery. 4 In addition, the deleterious effects of radiation to the soft tissue and skin result in fibrosis, induration, and ischemia.…”

Stroke after pituitary irradiation.

“…Discussion Accelerated atherosclerosis is a well-recognized complication of irradiation. 3 Initial reports of extracranial disease were soon followed by reports of intracranial vascular disease. 4 " 6 Small-vessel pathology includes fibrinoid necrosis, endothelial damage, adventitial fibrosis, and perivascular infiltrates of lymphocytes.…”