Tonomura Shuichi, Shimada Keiji, Funatsu Naoko, Kakehi Yoshiaki, Shimizu Hisao, Takahashi Nobuyuki
Department of Neurology, Nara City Hospital, Nara, Nara, Japan.
Department of Pathology, Nara City Hospital, Nara, Nara, Japan.
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):e39-e41. doi: 10.1016/j.jstrokecerebrovasdis.2017.08.039. Epub 2018 Jan 11.
Improved long-term survival of malignancy has drawn increased attention to late cerebrovascular toxicity after neck radiotherapy. Recently, neck radiotherapy has been found as a significant risk factor of carotid artery stenosis and ischemic stroke; however, long-term adverse effects of radiation in large arteries remain unknown. Here, we described an autopsied case with recurrent ischemic stroke associated with ipsilateral carotid artery stenosis several decades after neck radiation therapy. Pathologically, there were intima-media fibrosis, endothelial cell loss, and decreased expression of thrombomodulin in irradiated carotid artery stenosis. Our findings support the hypothesis that long-term radiation-induced vascular injury in large arteries is morphologically different from atherosclerotic change. Furthermore, endothelial cell injury may promote fibrin thrombus formation through decreased expression of thrombomodulin, which may cause ischemic stroke associated with radiation-induced carotid artery stenosis.
恶性肿瘤长期生存率的提高使得人们越来越关注颈部放疗后的晚期脑血管毒性。最近，颈部放疗已被发现是颈动脉狭窄和缺血性中风的一个重要危险因素；然而，大动脉放疗的长期不良影响仍然未知。在此，我们描述了一例颈部放疗数十年后出现复发性缺血性中风并伴有同侧颈动脉狭窄的尸检病例。病理检查发现，照射后的颈动脉狭窄处存在内膜中层纤维化、内皮细胞丢失以及血栓调节蛋白表达降低。我们的研究结果支持这样一种假说，即长期辐射诱导的大动脉血管损伤在形态学上与动脉粥样硬化改变不同。此外，内皮细胞损伤可能通过血栓调节蛋白表达降低促进纤维蛋白血栓形成，这可能导致与辐射诱导的颈动脉狭窄相关的缺血性中风。
