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.