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

Copyright © 2000 EDIZIONI MINERVA MEDICA

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


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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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