Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Yuan, Chuang; Wu, Weiju; Yip, Shea Ping; Kwong, Dora L.W.; Ying, Michael

doi:10.1055/s-0034-1399293

Cited by 15 publications

(18 citation statements)

References 35 publications

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“…The patients were asked to lie on the examination couch with their heads slightly reclined and turned away from the side that was assessed. 20,27 CIMT was measured manually in triplicates in three different angles (anterior, lateral, posterior) at the far wall of the left and right common carotid artery (CCA) 1 cm proximal of the carotid bulb. The measurements were made in plaque-free sequences of the CCA.…”

Section: Data Collectionmentioning

confidence: 99%

Association of epistaxis with atherosclerotic cardiovascular disease

2018

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Objectives/Hypothesis To investigate the association between epistaxis and atherosclerotic cardiovascular disease. Study Design Case‐control cohort study. Methods This study included patients from the tertiary‐care ear, nose, and throat department at the University Hospital of Zurich between December 1, 2016 and June 1, 2017. We assessed the cardiovascular risk profiles in a group of 41 patients presenting with epistaxis, and a group of 41 matched controls, focusing on a surrogate parameter for atherosclerosis: the carotid intima‐media thickness (CIMT). Results With a mean of 1.06 mm (standard deviation [SD] = 0.17), CIMT values were on average 26% higher in epistaxis patients than in their controls, with a mean of 0.84 mm (SD = 0.14; P < .001). Occurrence of severe epistaxis was also associated with lower ankle–brachial index values at 0.96 (SD = 0.12) versus 1.05 (SD = 0.17) (P < .001) and significantly higher QRISK2 relative risks (an algorithm for predicting cardiovascular risk) than found in the control group (1.81, SD = 0.97 vs. 1.35, SD = 0.28; P = .028). A binary logistic regression model, adjusted for possible confounders, showed an odds ratio of 2.5 for the occurrence of epistaxis per increase in CIMT of 0.1 mm in the study population (95% confidence interval: 1.56‐4.11; P < .001). Conclusions The occurrence of severe epistaxis was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease. Accordingly, patients affected by epistaxis should be regarded as at an elevated cardiovascular risk, which indicates the need for appropriate further medical assessment and preventive measures. Level of Evidence 3b Trial registration Clinical trials NCT03092973 Laryngoscope, 129:783–787, 2019

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Section: Data Collectionmentioning

confidence: 99%

Association of epistaxis with atherosclerotic cardiovascular disease

2018

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“…Our group previously reported that no significantly difference in CIMT existed in radiation-induced carotid atherosclerosis (post-RT NPC patients) compared to non-radiation-induced CA (diabetes patients without RT) (p cor =0.732), and higher CIMT was associated to male gender (p cor <0.01) and advanced age (p cor <0.01) (12). In present study, radiation-induced atherosclerosis was with a higher CIMT and more plaque numbers.…”

Section: Discussionmentioning

confidence: 83%

“…Rupture and erosion of CP may cause emboli, and induce the cerebrovascular events. Therefore, CA with the presence of CP increase the risk of cerebrovascular diseases (8,(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Exposure to the ionizing radiation caused DNA double strands damage of endothelial cells. When DNA damage repair could not suppress the damage, the constant injury accumulated and induced the expression of adhesion molecules, then promoting the atherosclerosis by facilitating the circulating immune cells anchoring on the endothelium, and resulting the advanced atherosclerosis through inflammation, cell apoptosis, proliferation and fibrosis(12,18).…”

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confidence: 99%

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Computer-assisted Ultrasound Assessment of Plaque Characteristics in Radiation-induced and Non-radiation-induced Carotid Atherosclerosis

Kwong

et al. 2020

Preprint

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Background Carotid atherosclerosis is common in post-radiotherapy (post-RT) patients and subjects with cardiovascular risk factors (CVRFs). The associated development of carotid plaques (CPs), particularly unstable plaques, is a major cause of cerebrovascular disease. Therefore, accurate detection and evaluation of CP characteristics is of essence. This study investigated the feasibility of using a computer-assisted method to evaluate and differentiate the CP characteristics in radiation-induced and non-radiation-induced CA. Methods 107 post-RT NPC and 110 CVRF subjects were recruited. Each participant had a carotid ultrasound examination of CPs and carotid intima-media thickness (CIMT). The carotid plaque characteristics were evaluated for grey-scale median (GSM) and detailed plaque texture analysis (DPTA) using specific computer software. In DPTA, five different intra-plaque components were color-coded according to different grey scale ranges. Multivariate regression model was used to evaluate the correlation of risk factors and carotid plaque characteristics. Results Post-RT NPC patients have significantly higher CIMT (748±15.1µm, p=0.001), more incidence of plaque formation (80.4%, p<0.001) and larger number of plaques (2.3±0.2, p<0.001) than CVRF subjects (680.4±10.0µm, 38.2% and 0.5±0.1 respectively). Among the five intra-plaque components, radiation-induced carotid plaques had significantly larger area of calcification (4.8 ±7.7%, p=0.012), but lesser area of lipid (42.1%±16.9%, p=0.034) when compared to non-radiation-induced CPs (3.0%±5.7% and 46.3%±17.9% respectively). Age, radiation and number of CVRF were significantly associated with the CA burden (p<0.001). Besides, age was significantly associated with the amount of lipid and calcification within CPs (p<0.001). Conclusions Compared to CVRF subjects, post-RT NPC patients were more susceptible to carotid plaque formation with less lipid content. Considering both CA burden and plaque component, both post-RT NPC patients and individuals with CVRF have a high risk of cerebrovascular diseases.

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“…In contrast to conventional two-dimensional RT (2D-RT), IMRT has been reported to have decreased risk of temporal lobe injury 9 and mastoiditis 10 . Nonetheless, the influence of IMRT on carotid stenosis remains unknown, nor is there a routine to screen patients post RT for carotid stenosis during follow up 11 . Therefore, to investigate the incidence of carotid artery stenosis (≥50%) and the risk factors with IMRT, we retrospectively analyzed 233 cases of NPC treated with IMRT, and compared with those treated with 2D-RT using Doppler ultrasound.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy

Zhou

Fan

Zheng

et al. 2018

Sci Rep

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Radiotherapy (RT) serves as the most efficient treatment for nasopharyngeal carcinoma (NPC) and can cause carotid stenosis. This work compared the incidence of significant carotid stenosis between intensity-modulated radiotherapy (IMRT) and two-dimensional conventional radiotherapy (2D-RT) for NPC and explored the risk factors. We retrospectively reviewed 233 cases with NPC who underwent carotid ultrasound post IMRT or 2D-RT from 2006 to 2015. The incidence of significant stenosis after RT was 19.3%. Significant stenosis was identified in 20 (14.6%) of 137 patients treated with IMRT and 25 (26.0%) of 96 patients with 2D-RT, respectively (p = 0.035). Multivariate logistic analysis indicated age (odds ratio = 1.054, 95% CI = 1.011–1.099, p = 0.014), radiation technique (IMRT) (odds ratio = 0.471, 95%CI = 0.241–0.919, p = 0.027) and time interval (odds ratio = 1.068, 95%CI = 1.033–1.105, p = 0.001) as independent predictors for significant carotid stenosis. Our study suggests that IMRT was associated with decreased incidence of significant carotid stenosis versus 2D-RT for NPC. Prevention and carotid ultrasound should be considered for older NPC survivors with longer interval from RT, especially those treated with 2D-RT.

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Ultrasound Evaluation of Carotid Atherosclerosis in Post-Radiotherapy Nasopharyngeal Carcinoma Patients, Type 2 Diabetics, and Healthy Controls

Cited by 15 publications

References 35 publications

Association of epistaxis with atherosclerotic cardiovascular disease

Association of epistaxis with atherosclerotic cardiovascular disease

Computer-assisted Ultrasound Assessment of Plaque Characteristics in Radiation-induced and Non-radiation-induced Carotid Atherosclerosis

Comparison of Significant Carotid Stenosis for Nasopharyngeal Carcinoma between Intensity-Modulated Radiotherapy and Conventional Two-Dimensional Radiotherapy

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