Neck Irradiation: a Risk Factor for Occlusive Carotid Artery Disease

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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“…Indeed, a hallmark of radiation vasculopathy is its occurrence in patients who lack traditional vascular risk factors. 7,66 …”

Section: Pathogenesismentioning

confidence: 99%

Ischemic Stroke and Transient Ischemic Attack After Head and Neck Radiotherapy

Plummer

Henderson

O’Sullivan

et al. 2011

Stroke

227

180

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“…Halak et al [19] recommended that follow-up should include yearly duplex scanning, beginning 3 years after completion of RT. Nevertheless, Cheng et al [3] recommended routine screening in patients who have received RT to the neck for >5 year because those patients had a 15 times higher chance of developing carotid stenosis.…”

Section: Follow-up and Prevention Strategiesmentioning

confidence: 99%

Radiation-Induced Carotid Artery Stenosis: A Comprehensive Review of the Literature

Cao

2013

Intervent Neurol

101

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In recent decades, with the improvement of radiotherapy (RT) technology and comprehensive treatment, the survival rate of head and neck malignancies has gained remarkable progress. Vascular injury and subsequent carotid stenosis following RT, as the backbone of treatment, have received increasing attention. Many investigations have demonstrated that radiation can result in the increase in carotid intima-media thickness, carotid stenosis and consequently lead to a higher risk of cerebrovascular events such as transient ischemic attack and stroke. In this review, we will examine the incidence of radiation-induced carotid artery stenosis, its morphological and histological characteristics, as well as its pathogenesis. The treatment and prevention methods, including follow-up strategies, will also be discussed at the end of the present review.

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“…External radiation to the neck area is a risk factor for development of carotid artery stenosis [1][2][3][4]. Patients who received radiotherapy to the neck have increased risk of developing transient ischemic attack (TIA), stroke, and retinal ischemic events [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Patients who received radiotherapy to the neck have increased risk of developing transient ischemic attack (TIA), stroke, and retinal ischemic events [1][2][3][4][5]. The time duration to development of an ischemic event after radiotherapy varies significantly among patients [5,6].…”

Section: Introductionmentioning

confidence: 99%