Extracranial carotid artery disease in nasopharyngeal carcinoma patients with post-irradiation ischemic stroke.
OBJECTIVE
Irradiation induced extracranial carotid occlusive disease has been recognized as a potential cause of post-irradiation stroke in nasopharyngeal carcinoma (NPC) patients. Our study aims to investigate the prevalence of extracranial CA disease in post-irradiated Taiwanese NPC ischemic stroke patients.


METHODS
Forty-three NPC patients with ischemic stroke were retrospectively selected from the stroke registration of the study hospital and compared with 276 first-ever ischemic stroke patients from the same database, of which 31 patients underwent carotid duplex sonography (CDS). Significant atherosclerotic lesions of the carotid arteries were defined as a >50% stenosis or an occlusion according to CDS.


RESULTS
Significant carotid lesions occurred in 13 of 31 (42%) NPC patients. Stroke was more frequently caused by large artery disease (44% versus 23%; p<0.01) in NPC patients than in first-ever stroke patients without NPC. Carotid artery disease (odds ratio 7.22, 95% confidence interval 2.51-20.77; p<0.0001) and absence of diabetes mellitus (odds ratio 0.26, 95% confidence interval 0.07-0.93; p=0.039) were the strongest independent discriminators between NPC stroke patients and non-NPC stroke patients in a multivariate logistic regression analysis.


CONCLUSIONS
Patients who received neck irradiation are at risk for the delayed development of diffused atherosclerosis but also for carotid occlusion within years, although the mechanism remains elusive and probably multifactorial.
Li
Chuei-Shiun
CS
Department of Neurology, Tian-Sheng Memorial Hospital, Pingtung, Taiwan.
Schminke
Ulf
U
Tan
Teng-Yeow
TY
D000368:Aged; D002277:Carcinoma; D002339:Carotid Arteries / Q000473:pathology / Q000528:radiation effects; D020212:Carotid Artery Injuries / Q000209:etiology / Q000473:pathology; D016893:Carotid Stenosis / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy; D011832:Radiation Injuries / Q000150:complications* / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology* / Q000473:pathology