buy streets and trips 2010 cheap microsoft office packages buy windows 7 digital copy
sildenafil canada buy cialis online without a prescription cheapest tadalafil sildenafil patent australia can you buy generic viagra in australia viagra newcastle nsw windows 7 ultimate download purchase rosetta stone english corel painter 11 for mac os x 10.6 buy adobe dreamweaver cc 2014 buy microsoft 2007 professional buy photoshop cs4 extended retail buy photoshop elements cheap cheap adobe cs6 for mac

Ischemic Stroke, Transient Ischemic Attack after Head & Neck Radiotherapy

Fri, Aug 5, 2011

Oral Cancer News

Source: AHA Journals
Author: Chris Plummer, PhD; Robert D. Henderson, PhD; John D. O’Sullivan, MD; Stephen J. Read, PhD

Abstract

Background and Purpose—Cerebrovascular disease can complicate head and neck radiotherapy and result in transient ischemic attack and ischemic stroke. Although the incidence of radiation vasculopathy is predicted to rise with improvements in median cancer survival, the pathogenesis, natural history, and management of the disease are ill defined.

Methods—We examined studies on the epidemiology, imaging, pathogenesis, and management of medium- and large-artery intra- and extra-cranial disease after head and neck radiotherapy. Controlled prospective trials and larger retrospective trials from the last 30 years were prioritized.

Results—The relative risk of transient ischemic attack or ischemic stroke is at least doubled by head and neck radiotherapy. Chronic radiation vasculopathy affecting medium and large intra- and extra-cranial arteries is characterized by increasing rates of hemodynamically significant stenosis with time from radiotherapy. Disease expression is the likely consequence of the combined radiation insult to the intima-media (accelerating atherosclerosis) and to the adventitia (injuring the vasa vasorum). Optimal medical treatment is not established. Carotid endarterectomy is confounded by the need to operate across scarred tissue planes, whereas carotid stenting procedures have resulted in high restenosis rates.

Conclusions—Head and neck radiotherapy significantly increases the risk of transient ischemic attack and ischemic stroke. Evidence-based guidelines for the management of asymptomatic and symptomatic (medium- and large-artery) radiation vasculopathy are lacking. Long-term prospective studies remain a priority, as the incidence of the problem is anticipated to rise with improvements in postradiotherapy patient survival.

Print Friendly
Be Sociable, Share!
, , , , , , ,

Leave a Reply

You must be logged in to post a comment.