J Clin Neurol.  2018 Jan;14(1):35-42. 10.3988/jcn.2018.14.1.35.

Changes in the Common Carotid Artery after Radiotherapy: Wall Thickness, Calcification, and Atherosclerosis

• Kim BJ
• Kang HG
• Lee SW
• Jung J
• Lee MH
• Kang DW
• Kim JS
• Kwon SU

• KMID: 2399597
• DOI: http://doi.org/10.3988/jcn.2018.14.1.35

Abstract

BACKGROUND AND PURPOSE
Since the long-term survival rate has improved in laryngeal cancer patients who receive radiotherapy, concerns about postradiation complications (including carotid atherosclerosis) have increased. We followed changes in the common carotid artery (CCA) after radiotherapy and identified the underlying risk factors.
METHODS
Consecutive patients with laryngeal cancer who underwent radiotherapy between January 1999 and December 2009 and who had received computed tomography (CT) both pre- and postradiotherapy were enrolled. Changes in the wall thickness and in the vessel and lumen areas as well as the presence of calcification or atherosclerosis were investigated. Demographics and risk factors were compared between patients with and without atherosclerosis at follow-up CT.
RESULTS
In total, 125 patients were enrolled. The wall thickness had increased and the lumen area had decreased several months after radiotherapy. These changes were not associated with vascular risk factors and were not progressive. Calcification and atherosclerosis were observed in 37 (29.6%) and 71 (56.8%) patients, respectively. Diabetes was associated with calcification (p=0.02). The prevalence of hyperlipidemia was higher in patients with atherosclerosis (28.2% vs. 11.1%, p=0.02) and for a longer period postradiation [62.7±32.1 vs. 40.0±24.2 months (mean±SD), p < 0.001]. Atherosclerosis occurred mostly in the middle portion of the CCA (n=31, 24.6%), followed by the proximal CCA at the intrathoracic level (n=26, 20.6%) and the distal CCA (n=6, 4.8%). Positive remodeling was also observed, but this was less common in patients with calcification (p=0.02).
CONCLUSIONS
Various types of postradiation changes occur in the CCA and can be easily observed in postradiation CT. The prevalence and burden of postradiation atherosclerosis increased in a close relationship with baseline cholesterol levels and the time after radiotherapy. Postradiation atherosclerosis was observed at unusual sites of the CCA.

Keyword

radiotherapy; carotid artery; atherosclerosis; hypercholesterolemia

MeSH Terms

Atherosclerosis*
Carotid Arteries
Carotid Artery, Common*
Cholesterol
Demography
Follow-Up Studies
Humans
Hypercholesterolemia
Hyperlipidemias
Laryngeal Neoplasms
Prevalence
Radiotherapy*
Risk Factors
Survival Rate
Cholesterol

Figure

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  Fig. 1 Measurements of pre- and postradiotherapy changes in the common carotid artery: vessel wall thickness, vessel area, and lumen area (A), calcification (B), and degree of stenosis (C).

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  Fig. 2 Factors affecting postradiation changes in the common carotid artery (CCA). Postradiation changes in the CCA according to the time after radiotherapy, including changes in the vessel wall thickness and lumen area (A) and the vessel area and degree of stenosis at the location of maximum stenosis resulting from atherosclerosis (B). Factors associated with the degree of stenosis (C).

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