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Cardiovascular Complications of Cranial and Neck Radiation

  • Syed S. Mahmood
  • Anju NohriaEmail author
Cardio-oncology (M Fradley, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology

Opinion statement

Cancer survivors who receive head and neck radiation are at increased risk for cerebrovascular events. This is mediated via damage to the hypothalamus-pituitary 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 follow-up for the development of pan-hypopituitarism 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 radiation-induced 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 post-operative 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 long-term 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.

Keywords

Cardio-oncology Carotid artery disease Radiation 

Notes

Compliance with Ethical Standards

Conflict of Interest

Syed S. Mahmood and Anju Nohria each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Cardio-oncology ProgramBrigham and Women’s Hospital/Dana Farber Cancer InstituteBostonUSA

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