student discount adobe indesign 
cheap adobe illustrator for mac 
download microsoft office word 2004 mac 
buy windows 7 full software buy adobe premiere pro cs5 cheap windows 7 home premium oem buy office for mac 2011 student used solidworks license for sale cheap autocad lt software is viagra prescription only in australia viagra generic in australia buy viagra in brisbane australia
amoxicillin and clavulanate amoxicillin order online canada fluconazole tablets ip 150 mg uses
viagra kaufen in der schweiz viagra femme achat de viagra en ligne
cipro no prescription 
fluconazole pills over the counter 
fluconazole tablets ip side effects 
allopurinol vente ciprofloxacin 500mg propranolol mg

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.