Unknown internal carotid artery atherosclerotic stenoses detected with biphasic multidetector computed tomography for head and neck cancer

Abstract

The possibility of detecting unknown internal carotid artery stenoses in patients undergoing biphasic multidetector computed tomography (MDCT) for current or previous head and neck cancer was investigated in 52 patients who underwent four-row MDCT (4 mm x 1.25 mm collimation, pitch 3, kVp 120, mAs 140; 90-100 ml of non-ionic contrast agent at 2 ml/s, early and late phases). Vessel stenoses were classed as severe (70-99%), moderate (30-69%), or mild (<30%). Internal carotid arteries (ICAs) with vessel stenosis was found in 37 patients (age 67.0+/-9.8 years, median 69 years) and 67 ICAs. Four patients (age 65.5+/-9.7 years) had severe stenosis, all of them associated with contralateral moderate stenosis. Seventeen patients (age 70.35+/-9.78 years) had moderate stenosis, bilateral (n=7), associated with contralateral mild stenosis (n=8), unilateral (n=2). Sixteen patients (age 64.8+/-9.8 years) had mild stenosis, bilateral (n=10) or unilateral (n=6). Of the four patients with unknown MDCT-detected severe stenosis, three had a change of therapy: one endarterectomy before tumor surgery, one combined vascular and tumor surgery, and one patient with a previously treated hypopharyngeal cancer had carotid stenting. In conclusion, of 52 patients, four (7.7 %) had unknown severe ICA stenoses, three of them with relevant impact on therapy. ICAs should be carefully evaluated for atherosclerotic disease using biphasic MDCT for head and neck cancer.

Carotid endarterectomy for the management of carotid stenosis occurring concurrently with head and neck cancer

“…There were no perioperative deaths or strokes [35] ]. Three other individual cases have also been reported separately in the literature, with the patient doing well in all three cases [36,37,38]. Likewise, in a recent case from our institution, a patient with two synchronous oral cavity squamous cell carcinomas and bilateral >70% asymptomatic carotid stenosis underwent total glossectomy, right neck dissection with CEA of the common and internal carotid artery, and radial forearm free flap.…”

Correlation of Color Doppler with Multidetector CT Angiography Findings in Carotid Artery Stenosis

“…Annular calcification and thick artery walls also cause difficulties in the US diagnosis. In such cases, other diagnostic methods may be performed: subtraction digital angiography (DSA), MDCTA, or magnetic resonance angiography (MRA) [10,11,12,13,14,15,16,17,18,19,20]. Agreement between multidetector row computed tomography (CT), MDCTA, and CD-US in measuring carotid artery wall thickness (CAWT) and the intima-media thickness (IMT) [21] has been applied recently.…”

Radiation‐associated carotid artery atherosclerosis: case report and review of contemporaneous literature

“…Dentists treating patients who have received therapeutic irradiation to the head and neck for management of malignant disease have traditionally devoted their efforts to surveillance for signs of new or recurrent disease, managing xerostomia and preventing the development of osteoradionecrosis 6 . In the past 10 years researchers have noted that radiation therapy is associated with a stroke‐provoking accelerated form of atherosclerosis (atheroma formation) in the cervical portion of the carotid artery which may be detectable by panoramic radiography 7 …”