Cardiovascular Complications of Cranial and Neck R

Authors: Syed S Mahmood Anju Nohria

Publish Date: 2016/05/16

Volume: 18, Issue: 7, Pages: 45-

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Abstract

Cancer survivors who receive head and neck radiation are at increased risk for cerebrovascular events This is mediated via damage to the hypothalamuspituitary axis leading to the metabolic syndrome and extracranial arterial injury leading to carotid artery stenosis Head and neck radiation can also lead to intracranial injury that can present as moyamoya especially in children Survivors require lifelong periodic followup for the development of panhypopituitarism or its individual components as well as for dyslipidemia and obesity Aggressive control of traditional cardiovascular risk factors is recommended to reduce cardiovascular morbidity and mortality There are no specific guidelines for the surveillance and management of asymptomatic carotid artery disease in cancer survivors However regular detailed examination for carotid bruits and neurological symptoms is recommended Treatment of significant radiationinduced carotid artery disease has not been specifically studied and is based upon recommendations for patients with atherosclerotic carotid stenosis Carotid endarterectomy can be difficult in radiation patients due to anatomic concerns and the risk of postoperative cranial nerve injury and wound complications but should be considered in patients with suitable anatomy and neck architecture Carotid artery stenting while successful may be associated with greater longterm mortality and neurologic complications Regardless of the strategy employed radiation patients are at increased risk for restenosis and should undergo routine surveillance even after revascularization

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