Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland.
Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
Vasa. 2020 Oct;49(6):467-473. doi: 10.1024/0301-1526/a000896. Epub 2020 Jul 17.
: Radiotherapy for head and neck cancer (HNC) represents a well-known predisposing factor for asymptomatic carotid artery lesions and acute cerebrovascular accidents. Our aim is to provide contemporary estimates on the prevalence, severity, and characteristics of carotid artery lesions in HNC survivors. : We prospectively included HNC patients who underwent radiotherapy and were free from the disease at the time of duplex ultrasound evaluation. Patients were re-contacted telephonically and those who agreed to participate were invited for an ambulatory visit when the investigators collected clinical information and performed duplex ultrasound examination based on a predefined protocol. : A total of 156 patients were included and underwent duplex ultrasound examination after a mean of 65.2 months from the last session of radiotherapy. A total of 36 patients (23.1%) had normal carotid arteries; mild, non-stenotic lesions were observed in 49.4% (n = 77) of patients; severe stenotic plaques were found in 27.5% (n = 43) of patients. One patient found with an asymptomatic occlusion of the left ICA. The prevalence of major cardiovascular risk factors and high radiation dose increased proportionally with plaque severity. Low echogenicity plaque was found in 59 (37.8%) patients on the right side and 57 (36.5%) on the left side; long segment plaque in 49 (31.4%) patients on the right side and in 47 (30.1%) on the left side; an atypical location of the lesions in 42 (26.9%) patients on the right side and in 48 (30.8%) on the left side. : The prevalence of occlusion and severe stenosis after radiotherapy for HNC was very low in our study population. Low echogenicity plaque, long segment plaque, and an atypical location were common findings. Classic cardiovascular risk factors appear to have had a causative role: a routine screening of radiotherapy-treated patients might be necessary only in patients with concomitant cardiovascular risk factors or exposed to high-dose neck radiation.
头颈部癌症（HNC）的放射治疗是无症状颈动脉病变和急性脑血管意外的已知诱发因素。我们的目的是提供关于 HNC 幸存者颈动脉病变的患病率、严重程度和特征的当代估计。
我们前瞻性地纳入了接受放射治疗且在双功能超声评估时无疾病的 HNC 患者。通过电话联系患者，那些同意参加的患者在调查人员根据预设方案收集临床信息并进行双功能超声检查时，应邀进行门诊就诊。
共有 156 名患者入组，在放疗结束后平均 65.2 个月接受了双功能超声检查。共有 36 名患者（23.1%）的颈动脉正常；49.4%（n=77）的患者有轻度、非狭窄性病变；27.5%（n=43）的患者有严重狭窄斑块。一名患者发现左侧颈内动脉无症状闭塞。主要心血管危险因素和高剂量辐射的患病率与斑块严重程度成正比增加。右侧发现低回声斑块的患者 59 例（37.8%），左侧发现低回声斑块的患者 57 例（36.5%）；右侧长节段斑块的患者 49 例（31.4%），左侧长节段斑块的患者 47 例（30.1%）；右侧病变位置不典型的患者 42 例（26.9%），左侧病变位置不典型的患者 48 例（30.8%）。
在我们的研究人群中，HNC 放射治疗后的闭塞和严重狭窄的患病率非常低。低回声斑块、长节段斑块和不典型位置是常见的发现。经典的心血管危险因素似乎起了致病作用：只有在伴有心血管危险因素或暴露于高剂量颈部辐射的患者中，才需要对接受放射治疗的患者进行常规筛查。
