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Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study

  • Vascular-Interventional
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Abstract

Objectives

To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT).

Methods

In this retrospective study, 62 patients (41 males; mean age 63 years; range 52–81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis.

Results

In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm3; p = 0.001), in the fatty plaques (103 vs. 202 mm3; p = 0.001) and mixed plaque component volume (328 vs. 419 mm3; p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found.

Conclusions

Results

of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component.

Key Points

HNXRT increases carotid plaque volume.

Plaque volume increase is mainly due to increase.in fatty plaque component

Patients who undergo HNXRT have a progression of carotid artery disease.

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References

  1. Gassmann A (1899) Zur histologie der rontgenulcera. Fortschritte Gebiete Röntgenstrahlen Nuklearmedizin Ergänzungsband 2:199–207

    Google Scholar 

  2. Dorresteijn LD, Kappelle AC, Boogerd W, Klokman WJ, Balm AJ, Keus RB, van Leeuwen FE, Bartelink H (2002) Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years. J Clin Oncol 20:282–288

    Article  PubMed  Google Scholar 

  3. Silverberg GD, Britt RH, Goffinet DR (1978) Radiation-induced carotid artery disease. Cancer 41:130–137

    Article  CAS  PubMed  Google Scholar 

  4. Haynes JC, Machtay M, Weber RS, Weinstein GS, Chalian AA, Rosenthal DI (2002) Relative risk of stroke in head and neck carcinoma patients treated with external cervical irradiation. Laryngoscope 112:1883–1887

    Article  PubMed  Google Scholar 

  5. Kang JH, Kwon SU, Kim JS (2002) Radiation-induced angiopathy in acute stroke patients. J Stroke Cerebrovasc Dis 11:315–319

    Article  PubMed  Google Scholar 

  6. Abayomi OK (2004) Neck irradiation, carotid injury and its consequences. Oral Oncol 40:872–878

    Article  PubMed  Google Scholar 

  7. Brant-Zawadzki M, Anderson M, DeArmond SJ, Conley FK, Jahnke RW (1980) Radiation-induced large intracranial vessel occlusive vasculopathy. AJR Am J Roentgenol 134:51–55

    Article  CAS  PubMed  Google Scholar 

  8. Zidar N, Ferluga D, Hvala A, Popović M, Soba E (1997) Contribution to the pathogenesis of radiation-induced injury to large arteries. J Laryngol Otol 111:988–990

    Article  CAS  PubMed  Google Scholar 

  9. Jordan LC, Duffner PK (2009) Early-onset stroke and cerebrovascular disease in adult survivors of childhood cancer. Neurology 73:1816–1817

    Article  PubMed  Google Scholar 

  10. Dorth JA, Patel PR, Broadwater G, Brizel DM (2014) Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy. Head Neck 36:215–219

    Article  PubMed Central  PubMed  Google Scholar 

  11. Greco A, Gallo A, De Virgilio A, Marinelli C, Macri GF, Fusconi M, Pagliuca G, de Vincentiis M (2012) Carotid stenosis after adjuvant cervical radiotherapy in patients with head and neck cancers: a prospective controlled study. Clin Otolaryngol 37:376–381

    Article  CAS  PubMed  Google Scholar 

  12. Truijman MT, Kooi ME, van Dijk AC, de Rotte AA, van der Kolk AG, Liem MI, Schreuder FH, Boersma E, Mess WH, van Oostenbrugge RJ, Koudstaal PJ, Kappelle LJ, Nederkoorn PJ, Nederveen AJ, Hendrikse J, van der Steen AF, Daemen MJ, van der Lugt A (2013) Plaque At RISK (PARISK): prospective multicenter study to improve diagnosis of high-risk carotid plaques. Int J Stroke. doi:10.1111/ijs.12167

    PubMed  Google Scholar 

  13. Saba L, Mallarini G (2009) Fissured fibrous cap of vulnerable carotid plaques and symptomaticity: are they correlated? Preliminary results by using multi-detector-row CT angiography. Cerebrovasc Dis 27(4):322–327

    Article  CAS  PubMed  Google Scholar 

  14. Homburg PJ, Rozie S, van Gils MJ, Jansen T, de Weert TT, Dippel DW, van der Lugt A (2010) Atherosclerotic plaque ulceration in the symptomatic internal carotid artery is associated with nonlacunar ischemic stroke. Stroke 41:1151–1156

    Article  PubMed  Google Scholar 

  15. Saba L, Anzidei M, Marincola BC, Piga M, Raz E, Bassareo PP, Napoli A, Mannelli L, Catalano C, Wintermark M (2013) Imaging of the Carotid Artery Vulnerable Plaque. Cardiovasc Intervent Radiol. 2013.

  16. van Gils MJ, Bodde MC, Cremers LG, Dippel DW, van der Lugt A (2013) Determinants of calcification growth in atherosclerotic carotid arteries; a serial multi-detector CT angiography study. Atherosclerosis 227:95–99

    Article  PubMed  Google Scholar 

  17. Saba L, Montisci R, Sanfilippo R, Mallarini G (2009) Multidetector row CT of the brain and carotid artery: a correlative analysis. Clin Radiol 64:767–778

    Article  CAS  PubMed  Google Scholar 

  18. Fure B, Wyller TB, Thommessen B (2005) TOAST criteria applied in acute ischemic stroke. Acta Neurol Scand 112:254–258

    Article  CAS  PubMed  Google Scholar 

  19. Saba L, Raz E, Anzidei M, Francone M, Piga M (2013) Differences in plaque morphology and correlation of stenosis at the carotid artery bifurcation and the carotid siphon. AJR Am J Roentgenol 201:1108–1114

    Article  PubMed  Google Scholar 

  20. Saba L, Sanfilippo R, Sannia S, Anzidei M, Montisci R, Mallarini G, Suri JS (2012) Association between carotid artery plaque volume, composition, and ulceration: a retrospective assessment with MDCT. AJR Am J Roentgenol 199:151–156

    Article  PubMed  Google Scholar 

  21. de Weert TT, Ouhlous M, Zondervan PE, Hendriks JM, Dippel DW, van Sambeek MR, van der Lugt A (2005) In vitro characterization of atherosclerotic carotid plaque with multidetector computed tomography and histopathological correlation. Eur Radiol 15:1906–1914

    Article  PubMed  Google Scholar 

  22. de Weert TT, de Monyé C, Meijering E, Booij R, Niessen WJ, Dippel DW, van der Lugt A (2008) Assessment of atherosclerotic carotid plaque volume with multidetector computed tomography angiography. Int J Cardiovasc Imaging 24:751–759

    Article  PubMed Central  PubMed  Google Scholar 

  23. Wethal T, Nedregaard B, Andersen R, Fosså A, Lund MB, Günther A, Kvaløy S, Fosså SD, Kjekshus J (2014) Atherosclerotic lesions in lymphoma survivors treated with radiotherapy. Radiother Oncol 110:448–454

    Article  PubMed  Google Scholar 

  24. Sattler MG, Vroomen PC, Sluiter WJ, Schers HJ, van den Berg G, Langendijk JA, Wolffenbuttel BH, van den Bergh AC, van Beek AP (2013) Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone. Int J Radiat Oncol Biol Phys 87:53–59

    Article  PubMed  Google Scholar 

  25. Fajardo LF (1999) Is the pathology of radiation injury different in small vs large blood vessels? Cardiovasc Radiat Med 1:108–110

    Article  CAS  PubMed  Google Scholar 

  26. Plummer C, Henderson RD, O'Sullivan JD, Read SJ (2011) Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke 42:2410–2418

    Article  PubMed  Google Scholar 

  27. Rockman CB, Riles TS, Fisher FS, Adelman MA, Lamparello PJ (1996) The surgical management of carotid artery stenosis in patients with previous neck irradiation. Am J Surg 172:191–195

    Article  CAS  PubMed  Google Scholar 

  28. Steele SR, Martin MJ, Mullenix PS, Crawford JV, Cuadrado DS, Andersen CA (2004) Focused high-risk population screening for carotid arterial stenosis after radiation therapy for head and neck cancer. Am J Surg 187:594–598

    Article  PubMed  Google Scholar 

  29. Xu D, Hippe DS, Underhill HR, Oikawa-Wakayama M, Dong L, Yamada K, Yuan C, Hatsukami TS (2014) Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score. JACC Cardiovasc Imaging 7:366–373

    Article  PubMed Central  PubMed  Google Scholar 

  30. Hong JC, Kruser TJ, Gondi V, Mohindra P, Cannon DM, Harari PM, Bentzen SM (2013) Risk of cerebrovascular events in elderly patients after radiation therapy versus surgery for early-stage glottic cancer. Int J Radiat Oncol Biol Phys 87:290–296

    Article  PubMed  Google Scholar 

  31. Huang YS, Lee CC, Chang TS, Ho HC, Su YC, Hung SK, Lee MS, Chou P, Chang YH, Lee CC (2011) Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy. Oral Oncol 7:1092–1097

    Article  Google Scholar 

  32. Wintermark M, Jawadi SS, Rapp JH, Tihan T, Tong E, Glidden DV, Abedin S, Schaeffer S, Acevedo-Bolton G, Boudignon B, Orwoll B, Pan X, Saloner D (2008) High-resolution CT imaging of carotid artery atherosclerotic plaques. AJNR Am J Neuroradiol 29:875–882

    Article  CAS  PubMed  Google Scholar 

  33. van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DW, Niessen WJ, van der Lugt A (2012) Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol 33:1267–1273

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Luca Saba. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. . No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Correspondence to Luca Saba.

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Anzidei, M., Suri, J.S., Saba, L. et al. Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study. Eur Radiol 26, 72–78 (2016). https://doi.org/10.1007/s00330-015-3753-9

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  • DOI: https://doi.org/10.1007/s00330-015-3753-9

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