Irradiation-induced Extracranial Carotid Stenosis in Patients with Head and Neck Malignancies

Background: Carotid stenosis is a recognized complication of external irradiation to the head and neck for malignancy. This study aim to investigate the pattern and prevalence of radiation induced carotid disease, and to identify risk factors associated with significant stenosis.

Methods: In a comparative cross-sectional study, carotid arteries color flow duplex scan was performed on 240 patients who had received external irradiation to the head and neck area, with a mean interval of 72 months from radiotherapy. They consisted of 181 men and 59 women, with a mean age of 59 years. Fifteen patients had a history of cerebrovascular symptoms.

Results: Internal carotid artery (ICA) stenosis of 70% or greater was detected in 29 arteries in 24 patients. Common carotid artery (CCA) disease of > or =70% was present in 13 arteries in 12 patients. Overall 28 patients had significant ICA/ CCA disease (11.7%). Patients with nasopharyngeal and laryngeal carcinoma had more cerebrovascular symptoms, and more frequent CCA stenosis. Significant ICA/CCA stenosis was associated with age, smoking, coronary heart disease, stroke, no head and neck surgery, time interval from radiotherapy, and the site of primary tumor. On logistic regression analysis age (>60 years), cerebrovascular symptoms, interval from irradiation (>5 years), and nasopharynx and larynx cancer were found to be independent significant (P<0.05) predictors of 70% or greater ICA/CCA stenosis.

Conclusions: Patients who had received radiotherapy to the head and neck have a high risk of developing significant carotid stenosis. Routine duplex ultrasound screening in these patients is indicated.