Histopathological Examination of Ruptured Carotid Artery after Irradiation

Abstract

We report 2 cases of carotid artery rupture after irradiation that was performed 1 year and 17 years before the ruptures. When irradiation-induced arterial rupture occurs, it usually does so within a few months following irradiation. However, the histopathological sections obtained in the present cases revealed carotid artery necrosis that was presumably induced by irradiation. Carotid artery rupture is sudden, massive hemorrhage that ranks among the most dreaded complications in the head and neck. However, several patients have been saved by hospital personnel who discovered the rupture in time to take appropriate measures such as cleaning of the wound and protection with myocutaneous or myofascial flaps. Therefore, it is important to be aware of the possibility of rupture or perforation of major vessels after irradiation, even when the radiation therapy was performed a long time ago.

Carotid Tortuosity in Patients With Prior Cervical Radiation

“…Degradation of the intima and media of the arterial wall secondary to radiation therapy has been previously demonstrated, sometimes even leading to wall necrosis and rupture. [17][18][19][20] Although elongation and tortuosity of the carotid artery in response to radiation therapy has not yet been described, it appears that the deleterious effects of radiation injury to the vessel wall include degenerative changes that may ultimately lead to elongation and tortuosity.…”

Acute Arterial Hemorrhage Following Radiotherapy of Oropharyngeal Squamous Cell Carcinoma

“…Radiation-induced vascular changes varied from atherosclerosis to necrotizing vasculitis characterized by fragmentation of the internal elastic lamellae, focal medial necroses or edema and inflammatory infiltration predominantly by polymorphonuclear leukocytes of adventitia, media and intima [8]. These radiation-induced late effects seem to be caused by chronic oxidative stress [21].…”

“…Common side effects of R(C)T are erythema, erosion and ulceration of the skin and mucosa, xerostomia, interstitial lymphedema, fibrosis of the soft tissue, and, in severe cases, necrosis of bone or cartilage [8]. It is discussed, that radiation-induced late effects like chronic inflammation, organ dysfunction, fibrosis and necrosis are driven, in part, by chronic oxidative stress [21].…”

Case of three delayed complications of radiotherapy: Bilateral vocal cord immobility, esophageal obstruction and ruptured pseudoaneurysm of carotid artery

“…Irradiation also causes fragmentation of the elastic fibers of the tunica media, as well as subendothelial vascularization and edema. These conditions are thought to contribute to aneurysm formation of large irradiated arteries and the rupture of arteries [4,5]. Pseudoaneurysm formation of the carotid artery due to irradiation is extremely rare [6][7][8][9].…”