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Journal of Neurosurgical Sciences 2000 September;44(3):159-64

language: English

Radiation inju­ry involv­ing the inter­nal carot­id ­artery. Report of two cas­es

Santoro A., Bristot R., Paolini S., Di Stefano D., Cantore G.

Dipartimento di Scienze Neurologiche, Neurochirurgia I, Università ­degli Studi “La Sapienza”, Rome, Italy


Radiation ther­a­py is an uncom­mon ­cause of sten­o­sis and occlu­sions of the cer­vi­cal inter­nal carot­id ­artery (ICA). We ­describe two cas­es of cere­bral ische­mia due to ICA sten­o­sis in ­patients irra­di­at­ed for malig­nant ­tumors (lym­pho­ma and ­breast can­cer). The ­first ­patient, a 32-­year-old man, pre­sent­ed ­with an epi­sode of cere­bral ische­mia. Six ­years pre­vi­ous­ly he had ­received irra­di­a­tion ther­a­py for a ­left later­o­cer­vi­cal ­mass his­to­log­i­cal­ly diag­nosed at biop­sy as a Hodgkin’s lym­pho­ma. Cerebral angio­gra­phy on ­entry ­revealed bilat­er­al occlu­sion of the cer­vi­cal ICA, ­with a 2-cm ­stump at the ori­gin of the ­left ICA. Despite ­anti-plate­let aggre­ga­tion ther­a­py the ischem­ic ­attacks per­sist­ed, neces­si­tat­ing a stum­pec­to­my. After vas­cu­lar-­repair sur­gery the ­patient had no fur­ther ischem­ic symp­toms. The sec­ond ­patient, a 42-­year-old wom­an, ­began to expe­ri­ence the sud­den ­onset of ­pain in the ­right arm and ­left hem­i­par­e­sis ­five ­years ­after sur­gery ­plus irra­di­a­tion (4500 ­rad) for ­breast can­cer, and ­three ­years ­after exci­sion of a sin­gle cere­bral metas­ta­sis. Cerebral angio­gra­phy ­obtained on admis­sion ­showed occlu­sion of the ­right ICA and ­right sub­cla­vian arter­ies, ­both ­lesions neces­si­tat­ing throm­bec­to­my. After sur­gery the ­right radi­al ­pulse imme­di­ate­ly re-ap­peared and the hem­i­par­e­sis ­regressed. In ­both ­patients, 2-­year fol­low-up assess­ment by Doppler ultra­so­nog­ra­phy and mag­net­ic res­o­nance angio­gra­phy (MRA) con­firmed ­that the oper­at­ed arter­ies ­remained pat­ent. These two unusu­al cas­es under­line the poten­tial ­risk of irra­di­a­tion-­induced ischem­ic cereb­ro­vas­cu­lar symp­toms, sug­gest­ing ­that ­patients who ­have ­received radi­a­tion ther­a­py to the ­neck and med­i­as­ti­num who sur­vive for ­more ­than 5 ­years ­should under­go reg­u­lar non-inva­sive imag­ing of ­neck ves­sels (Doppler ultra­so­nog­ra­phy and MRA).

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