NeurovascularMedicine.com
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Radiation Vasculopathy


Learning objectives

  • What is Radiation Vascuopalthy
  • Recognition of Radiation Vascuopalthy
  • Treatment of Radiation Vascuopalthy

Introduction

  • Stroke can complicate head and neck radiotherapy and result in TIA/Stroke disease

Introduction

  • Occlusive radiation vasculopathy is is marked by its delayed presentation years after treatment
  • Children and adults develop netlike vessels and transdural anastomoses which can mimic moyamoya disease
  • In the past patients died of their malignancy but less so now and they live long enough to develop strokes

Tumours needing Radiation therapy

  • Squamous cell carcinoma of the head and neck
  • Lymphoma and breast cancer were the main tumour types targeted by neck XRT
  • Pituitary tumours in adults and optic pathway gliomas in children
  • Nasopharyngeal carcinoma, in which both carotids are typically involved in the field

Clinical

  • Clinical syndromes related to ischaemic stroke, transient ischemic attack (TIA), or carotid stenosis

Investigations

  • CT/A may show strictures and narrowing
  • Carotid duplex may show narrowing

Differentials

Management

  • Carotid endarterectomy is difficult as tissue is scarred and stenting may be more appropriate for severe carotid stenosis but with high restenosis rates.

References and further reading


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