I would like to know how common hardening of the carotid arteries is after having radiation to the head and neck. I was told that it could be a possibility. I am two years post Tx and have seen quite a few cases posted on other websites where patients have developed hardening of the carotid arteries even many years post radiation. It also seems that most of those people cannot seem to find a doctor experienced enough to correct the problem other than a stent. Any information on this will be appreciated.

Hi,
I'm not certain how common this it but I do know blockage of the carotid arties is one of the possible side effects from radiation and neck dissections. I was 11 years out last year when my right carotid was found to be more then 90% blocked. Because of radiation and the mess made by the neck dossection, they will NOT do surgery on the carotid. The only solution was a stent which I might prefer anyhow. So far so good and it has not clogged again. I was also put on Plavix and a 325 aspirin. My cholestral is normal on medication and my HDL runs around 90-100.

So yes, this is another one of those things that can happen from the 'gift that keeps on giving'. Keep an eye on it and get it repaired if needed.

Take care,
Eileen

Eileen,

Did they say medically why either the rad or the ND or the combo causes that condition?

Yes. Apparently the radiation causes the artery to narrow and in my case the ND caused the carotid to become very convolulted, like a paper clip that had been pried open making it very tricky business to put in a stent. The vascular surgeon at HUP decided he would not do the surgery and when I said I didn't like that option, he sent me to a surgeon at Hahneeman who said he 'get your butt in here next week'. Stent was put in carotid a week later. No problems since.

One of the reasons I was so adamant about getting the stent is they said it was caused by radiation. Since I had XRT and my other carotid was about 40% blocked, I didn't want to wait until both were blocked and they could do nothing, like happened to my father.

Take care,
Eileen

This is all about the radiation and not about the dissections. The radiation causes scar tissue to form inside the artery narrowing it. Unlike all the conventional reasons that we have this happen (fatty diets etc.) this is really common in people that have H&N radiation. I too am about 50% occluded and am weighing options. There are issues between coated and uncoated stents and the procedure itself, all of which have risk factors. While it is a common procedure to do in the US in many areas of the vascular system, I personally have put it off in spite of the need and collateral issues, faintness, and more because of the complication rates. Somewhere in my future this is not going to be an option any longer.

Unlike other causes of occlusion/stenosis (to address the original post) opening the artery by other mechanisms where plaques and fatty deposits are the culprit the reasons we get this cannot be addressed by balloon angioplasty and other artery opening procedures. Stents seem to be the main solution.

Presumably those who have had H&N radiation should be advised about the risk of hardening of the arteries and perhaps adapt diets accordingly? BTW could radiation induced hardening of the cartoid artery cause headaches?

Anything is possible, but the most common complaint is dizziness and feeling faint on exercising or getting up from a supine position. Diet should always be a consideration, but as I said this is a different mechanism of cause, and while diet is capable of screwing up all your arteries equally, (so eating healthy is a good thing) but it is not going to improve what has happened to the carotids.

Brian,

Do you see this happening more with XRT patients than IMRT?

Are there any other symptoms to watch out for?

I assume this is a side effect that takes longer than most to show up?

I had absolutely no symptoms which is one of the reasons the doctor at HUP decided not to do the stent. My GP had picked up a gurgling sound in my neck on a routine BP visit and sent me for an utlra sound of the carotid. Mine was so occluded, one spot looked like someone had tied a string around it and pulled it tight. They said the neck dissection was the reason the artery was making several U turns and the reason that the only option is a stent. They don't want to operate on that area again.

Take care,
Eileen

My vascular surgeon seems to feel the same way. Stent is the
only course of action but he want to watch it until symtoms occur or the blockage is more severe now at 50-70% my PCP tripped out but the surgeon had more of a wait and see approcach due to the dangers of the surgery.

Keep a good eye on it. I was 70% in Decemeber and by June was 90%. Surgery was first week of September and had I waited any longer, they would not have been able to do it. The stent is fairly low on surgical complications although I did have a couple of interns that did their best to kill me. What a comedy of errors.

Take care,
Eileen

Even with IMRT patients David, it is a highly variable function of the field design of the radiation and duration + intensity. It's a given problem for those of us that came along before IMRT, but for those after, it is a function of mapping the field.

Understand the radiation field, duration and intensity logic so what about how long it takes to do the recognizable damage in the Carotid?

The problem is that the mechanism of damage that forms the scar tissue is not just immediate, but progressive. So most people do not have immediate occlusion of the vessels at the end of treatment, but they gradually develop them over years. Much like other collateral damages from radiation, and the list is long, it is progressive and gets worse with time. Other things that radiation does that are the same, and I will just use my own list to note a few, - Your ability to swallow initially gets better, but over time gets worse. The radiation damages nerves that control the muscular contractions in the back of your throat, and that control the peristalses waves that move the food down. Other nerve damage include the facial nerve that controls your ability to move certain facial muscles. I can't control the right side of my mouth, there is nothing mechanically wrong with the muscles, but the nerves that control them have become progressively degraded by the radiation treatments over time.

Again using my own situation I noticed no lightheadedness or other symptoms of carotid blockage in the first 5 years after treatment, though there was likely some small gradual insidious thickening of the walls during that time. After that it seemed to worsen much more rapidly. Clearly I am not an expert on this, but have had it explained to me by my cardiologist who consulted with several RO's to confirm his findings. Stents are somewhere in my future, but I am dragging my feet about it and dealing with the QOL issues until they get to a point where I no longer can do some of the things that are important in my life. Perhaps time will run out for me before I really have to have them done. Mack Trucks run wild and all other considerations factored in......

LOL Brian, stay away from Mack Trucks. Really I did enjoy this post and learned from it .

I appriciate so much all the usefull info I recieve here.
I just had a stent placed in my R Carotid Artery less than
4 years after my radition. My surgeon was shocked at the
lack of plaque and the 95% blockage after only 4 years I guess
it goes with the territory. I'm just happy my wonderfull Doctors at MD Anderson noticed the problem at my yearly check-up and made me aware of it I had no symtoms at all. The Stenting procedure was painless fast and uneventfull, thanfully
So for all of you who had Radiation to the neck make sure to
keep a close eye on your Carotid Artery.

mentn34,

How did they check the Artery? I have to be checked every few years for an abdominal aortic aneurysm, my father passed from this and it runs in the family. They do a fairly simple ultrasound to check it. I am overdue so next time I go in I can ask for the additional work while I�m there if that�s how they check.

I do my current checks to obtain a baseline diameter on the Aorta, so it might be a good thing to get on the Carotids.

I had a carotid ultrasound to check mine out as my migranes had stopped after radiation and they suspected this was the reason.

mentn34 - I would be interested in hearing more about your stenting procedure, and if they used coated or non coated stents. You make it sound pretty straightforward and uneventful.

They first check with a Doppler Ultrasound for an estimate we
then had a MRA_MRI then a arteriergram for a precise measure.
I must have had really good insurance at the time.(LOL)

My vascular surgeon said the most apropriate stent for the
coratid was the non coated. The procedure was shockingly
simple. No drugs they wanted me alert durring the procedure
(what a bummer) they numb where they make the incision then
put the catheter in they map your artey to your neck with contrast then run th wire in they use the angioplasty baloon
to open the artey and expand the stent. I forgot they put a filter or basket above the blockage to catch any debris that might break loose. I did have to take plavix and asprin for 5
days be4 the surgery and continue for 1 month. The worst part was having to lay flat for 2 hours afterwards with pressure to
the incission for the 1st 30 minutes. Procedure on Fri. left hospital Sat. AM back a work on Mon. My age probably helped I am only 49 but I hope to get alot older. I am really healthy
other than Cancer and Coratid The insurance companies love that
line.

Brian,
I had the same procedure Sept 2008. After the 1st hour of lying flat or however long it took to make certain the incision had clotted, I was transferred to a room in ICU where I had to lie flat, absolutely still, no talking, no food, for another 8 to ten hours. I was allowed a bed pan. I was on some drug via IV to bring up the blood pressure. They want it high when you leave the hospital. I wound up having to stay an extra day because some idiot doctor decided I HAD to take my BP meds and lowered my BP too low.

After what we've been through, this procedure was a piece of cake. Just make certain you have a top notch surgeon. I am on plavix and 325 aspirin for life.

Take care,
Eileen

Watch Plavix. I was taking it and ended up with the left side full of blood under my skin.

Yeh Jim,
I'm not happy with this Plavix and asperin routine but cardiologist insists. Everytime nurse draws blood, I wind up with huge bruise on my arm where she grabs it to hold steady. I had a reaction to an antiobotic that resulted in a horrible headache and because of the plavix, the only thing I can take is extra strength tylenol. Didn't do a thing for it.

Take care,
Eileen

I asked my radiologist about narrowing of the coratid artery and she suggested that my PCP keep an eye on it. My risk was low due to having IMRT. My PCP listened to the artery and thought I was fine. When I brought it up to my ENT, he said he generally recommends a baseline ultrasound. I'm Not sure why one was never suggested to me. The baseline showed both arteries was fine. This was about 2 months ago and I'm three years past treatment this month. I think he said he'd do another ultrasound in five years.

On another note...The ultrasound showed something amiss with my thyroid and I needed to return for a thyroid scan. Turns out I have some nodules, which came back benign after a fine needle aspiration was performed. The thyroid doctor will just watch the nodules over the next few years to see if they change. Only downside is I added another doctor to my list!

Hi there,

My partner has started complaining of slight light headedness on standing from sitting and carotid bruit. Am hoping this could be stenosis and nothing more serious. What is the drill? I am supposing that it needs fairly quick diagnosis for someone to make an estimate of how blocked it is as a means to establish how urgent the need for surgery is. Is that correct? BTW which medical speciality deals with this?

Brian did you eventually proceed with having something done. In which case what procedure did you opt for and why and how did it go?

Thanks
Cathy

They will probably do ultrasound first for estimate if blockage is greater than 70Percent they will do arteriergram
then decide whether to put a stent in. None of this is very
invasive I had my stent in on Fri. one night in hospital back
at work on Mon. morning. I also had CAT between the ultrasound
and arteriergram I thought that was a little over kill on the test but I had no symtoms.

I still have issues, but I have put off having a stent done for now. I have a consultation with a cardiologist in November the purpose of which is to weigh the pros and cons of it all. I think that at some point in the future this is a must do for me, and while the procedure is simple, it is not without a complication rate.

But even with all that I have read about it in the literature, I don't think I am competent to judge my own situation right now. We'll see what the future holds. I have some other issues that are more pressing right now that I have to deal with first. I will post after the consultation, what I have learned about success rates, complications, the difference in occlusion from rads vs. poor diet for a protracted period, etc. For sure this issue is common in head and neck patients.

Thanks for responding Mentn an Brian and sorry you have other issues Brian. I hope all is ok and many congratulations on your award. Well deserved.
Cathy

ps thank goodness for this site. When Chaz first mentioned lightheadedness I thought nothing of it, but later remembered having posted on a thread about it with relation to his headaches. Will be interesting to see with this is something his regular ENT consultant is aware of. Feel we have not really been given much info about post treatment side effects. At least i feel I can push them to explore Carotid problems. He had a normal ultrasound on the whole of his neck about 2 months ago. Would a problem with his carotid show up on that or is it something they would have to be particularly looking for?
C

I now have two stents in my right carotid, one right above the other. First one put in 2008, last one June 2010. Both were picked up on an ultrasound with stenosis > 90%. I was totally asymptomatic in 2008 and had very mild symptoms in 2010 which actually are probably my arhythmia rather than carotid since I still occasionally feel like I am passing out. Cardiac Doc picked it up on my routine 6 mo check up. No one was more surprised than me. Put me in the hosptial for surgery 2 days later. I have had no complications from the surgery. If he has had a ND, it is my understanding they will have to do a stent rather than surgery. This is easy in comparison to what we have been through.

Take care,
Eileen

Hi, I'm Joan Mason I have not posted in a bit but I am 22 years out from my treatment for cancer of the Larynx in 1988.
Since treatment ended I have had 3 carotid endorectomies I'm assumeing that because my 1st 2 surgeries were done by heart surgeons. I have been getting sonograms yearly since my treatment and at around 14 years I had my first surgery. I now have a vascular surgeon and he did the 3rd endorectomy and has placed 3 stents in my subclavian arteries, which also need to be watched. With each surgury I have more and more trouble with my swallowing and neck muscles ceasing to function properly. I have had to limit some foods, like breads, hamburgers, and french fries,etc.
I am now 60 years old now and Life is good - I would not trade the experience of having my cancer with anything.