Management of Radiation Induced Carotid Stenosis in Head and Neck Cancer

OBJECTIVES: Presentation of radiation-induced lesions in carotid arteries of patients with head and neck squamous cell carcinoma (HNSCC) and the evaluation of the effectiveness of endovascular treatment of symptomatic stenoses. MATERIALS AND METHODS: We retrospectively analyzed 26 patients who underwent surgery and subsequently cervical radiotherapy (RT) for HNSCC, focusing on radiation-induced vascular disease in neck arteries-from the latency period to the occurrence of neurological events-and the endovascular treatment of the internal carotid artery (ICA) and/or of common carotid artery (CCA) stenoses. The vascular lesions were diagnosed with Doppler ultrasonography and selective digital angiography. Patients with >70% stenoses of ICA and/or CCA were scheduled for carotid artery stenting (CAS). They were followed-up with neurological examinations and Doppler ultrasonography at 6, 12, and 24 months after stenting. RESULTS: Radiation-induced vascular diseases occurred in the ICA in 22 patients (85%), CCA in 15 (58%), and in ECA in 15 (58%). The stents were implanted in 25 ICA and 17 CCA. Thirteen patients (50%) had one stent, eight (30%) had two stents, four (15%) had three stents, and one patient had five stents. Overall, 46 stents were implanted. Technical success was achieved in all patients. No cerebrovascular events occurred in the 24-months follow-up. CONCLUSION: RT in patients with HNSCC holds a significant risk factor of developing carotid artery stenosis and cerebrovascular events. Carotid stenting is preferable mode of treatment for radiation-induced stenosis. A screening program with doppler ultrasonography enables pre-stroke detection of carotid stenosis.