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Article: Accelerated progression of carotid stenosis in patients with previous external neck irradiation

TitleAccelerated progression of carotid stenosis in patients with previous external neck irradiation
Authors
Issue Date2004
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jvs
Citation
Journal Of Vascular Surgery, 2004, v. 39 n. 2, p. 409-415 How to Cite?
AbstractObjective: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and Methods: The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (< 50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ultrasonography. Secondary end points included progression to higher disease category, new cerebrovascular symptoms, and death. Data from irradiated arteries was compared with control data with the life table method. A Cox regression model was used to analyze disease progression, adjusted for covariates of sex, age, smoking, diabetes, and hypertension. Results: Mean follow-up was 36 months. Adjusted freedom from progression rates at 3 years were 65% for irradiated arteries and 87% for control arteries at life-table analysis (P = .035; odds ratio, 3.1). The annualized progression rate from less than 50% to 50% or greater in irradiated arteries was 15.4%, compared with 4.8% in nonirradiated arteries. A long history of cervical irradiation (>6 years) was the only significant risk factor for disease progression. There was no difference between the two groups regarding development of new symptoms or mortality. Conclusions: Carotid stenosis associated with external irradiation progresses more rapidly compared with nonirradiated atherosclerotic arteries. Aggressive surveillance is recommended.
Persistent Identifierhttp://hdl.handle.net/10722/84317
ISSN
2015 Impact Factor: 3.454
2015 SCImago Journal Rankings: 2.115
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, SWKen_HK
dc.contributor.authorTing, ACWen_HK
dc.contributor.authorHo, Pen_HK
dc.contributor.authorWu, LLHen_HK
dc.date.accessioned2010-09-06T08:51:31Z-
dc.date.available2010-09-06T08:51:31Z-
dc.date.issued2004en_HK
dc.identifier.citationJournal Of Vascular Surgery, 2004, v. 39 n. 2, p. 409-415en_HK
dc.identifier.issn0741-5214en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84317-
dc.description.abstractObjective: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and Methods: The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (< 50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ultrasonography. Secondary end points included progression to higher disease category, new cerebrovascular symptoms, and death. Data from irradiated arteries was compared with control data with the life table method. A Cox regression model was used to analyze disease progression, adjusted for covariates of sex, age, smoking, diabetes, and hypertension. Results: Mean follow-up was 36 months. Adjusted freedom from progression rates at 3 years were 65% for irradiated arteries and 87% for control arteries at life-table analysis (P = .035; odds ratio, 3.1). The annualized progression rate from less than 50% to 50% or greater in irradiated arteries was 15.4%, compared with 4.8% in nonirradiated arteries. A long history of cervical irradiation (>6 years) was the only significant risk factor for disease progression. There was no difference between the two groups regarding development of new symptoms or mortality. Conclusions: Carotid stenosis associated with external irradiation progresses more rapidly compared with nonirradiated atherosclerotic arteries. Aggressive surveillance is recommended.en_HK
dc.languageengen_HK
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jvsen_HK
dc.relation.ispartofJournal of Vascular Surgeryen_HK
dc.rightsJournal of Vascular Surgery. Copyright © Mosby, Inc.en_HK
dc.titleAccelerated progression of carotid stenosis in patients with previous external neck irradiationen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0741-5214&volume=39 &issue=2&spage=409&epage=415&date=2004&atitle=Accelerated+progression+of+carotid+stenosis+in+patients+with+previous+external+neck+irradiationen_HK
dc.identifier.emailCheng, SWK: wkcheng@hkucc.hku.hken_HK
dc.identifier.authorityCheng, SWK=rp00374en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1016/j.jvs.2003.08.031en_HK
dc.identifier.pmid14743145-
dc.identifier.scopuseid_2-s2.0-0842267658en_HK
dc.identifier.hkuros87621en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0842267658&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume39en_HK
dc.identifier.issue2en_HK
dc.identifier.spage409en_HK
dc.identifier.epage415en_HK
dc.identifier.isiWOS:000188535000037-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridCheng, SWK=7404684779en_HK
dc.identifier.scopusauthoridTing, ACW=7102858552en_HK
dc.identifier.scopusauthoridHo, P=24469553100en_HK
dc.identifier.scopusauthoridWu, LLH=7404903103en_HK

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