Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer

Abstract

Conclusion: Prevalence of carotid arterial disease in patients with previous cervical radiation therapy is sufficiently high that screening for carotid artery stenosis should be routine. Summary: The authors used a prospectively maintained data base to identify patients who had received cervical high-dose radiotherapy (minimum, 5500 cGy). Patients were then screened with bilateral carotid duplex ultrasonund screening. Duplex findings were divided into those with normal or mild carotid artery stenosis (<50%) and significant carotid artery stenosis (>50%). Relationships between standard demographic risk factors and screening outcomes were also analyzed. Forty patients with a history of cervical radiation were screened in this study (mean age, 68.2 years; range, 26-87 years). Mean cumulative radiation dose was 6420 cGy (range, 5500-7680 cGy). There was a mean duration of 10.2 years since the last radiation treatment. Duplex ultrasound scans revealed that 40% of patients had significant carotid artery stenosis. Patients with and without significant stenosis were comparable in terms of radiation dose, tobacco use, age, comorbid conditions, and post-radiation intervals (P = NS). Six patients had unilateral carotid occlusion, and 6 patients had greater than 50% bilateral carotid stenosis. Eight patients (7.5%) had sustained a stroke after radiation therapy. Comment: The authors argue that the prevalence of carotid artery disease after radiation therapy warrants aggressive screening as part of post-radiation care. However, only 3 patients (7.5%) sustained a stroke after radiation therapy. Given the potential increased risk for carotid intervention in patients with previous radiation therapy, and perhaps decreased durability of carotid interventions in patients with radiation therapy, it may be that the authors' data suggest that screening for asymptomatic carotid artery stenosis is not indicated after radiation therapy.