Eshwar is right, it is a narrowing of the vessel. It isn't a sudden thing but happens over time. In people that just have bad health habits (don't exercise or eat right) two things happen; one is their arteries lose the elasticity (atherosclerosis) and the other is the become narrower when clogged with fatty deposits, plaques and calculus (stenosis). All this makes blood flow poorer and eventually, if they become narrow enough, the symptomology becomes something that you cannot ignore.

In radiated patients, it can be a combination of scar tissue forming in the artery from the radiation, narrowing it, and if they also came into cancer treatments with a poor diet etc. the plaques in addition to. Radiation itself causes atherosclerosis, so you get a double whammy.

Strokes happen when part of the deposits break off and travel downstream until they reach a blood vessel too small for them to pass through, and that's where the blood flow stops. Everything past that dies in very short order, and you have about 3 hours to introduce clot busting drugs to even hope for life to go back to something normal. They of course can be fatal. You can also have a stroke from a thrown blood clot, which often happens in people that have a bad heart valve, or damaged arterial wall. Depending on where the clot or plaque stops, things can get really dire quickly or not. Obviously in your brain, upstream from a carotid issue is a bad thing. Downstream from the heart to the femoral artery and leg is another thing.

My dad had a bad valve which threw a clot and he came home one day from walking the dog limping and rubbing his numb leg. He had no idea what had happened, until I called 911 and told them my dad had a stroke. He thought I was nuts and that it was a pinched nerve. After that was resolved, 9 months later he threw another clot which went to his brain and he lost his ability to talk, reason, and so much more. Days later he had a massive MI and that was that. Men in my family do not live past their early 70's going back for generations, and all die from the same thing. This is one of those nature and nurture things. Knowing all this I have been pretty careful about my health during my adult life. But even when you are doing everything possible, and armed with lots of knowledge, you can't change your genetic make up. But I never calculated that I would end up with an 80+% carotid stenosis a decade early� from radiation, not genetics.

In terms of radiation damage, is there anything to be done to get ahead of something like this? I am just finishing up IMRT for laryngeal SCC and if I can start a particular therapy now to get on top of this kind of damage I would love to know more about what could be done. Should I raise this issue with my RO/MO before I'm done?

Eshwar, thanks for the info! Does this have anything to do with lymphadema?

Cathi

Hi Cathi, lymphadema is lymphatic obstruction - a condition of localized fluid retention and tissue swelling. In context of cancer, it seen after lymph node dissection, surgery and/or radiation therapy, in which damage to the lymphatic system is caused during the treatment. In case you are facing any symptoms like painful or severe facial swelling or difficulty in breathing, you need to get in touch with your physician. Probably he'll refer you to certified lymphedema therapist depending on your case.

To hopefully alleviate Brian's concerns about the stent ... my riding instructor is in his mid sixties (although not a cancer survivor) and underwent a triple bypass (much more exciting than a stent). Today he is back to riding 6-8 horses a day, and can casually toss about 70# hay bales.

Brian, first off I wish you well. More than well. I hadn't known about this issue until I read the piece here on the site. Interesting that none of my doctors brought it up. Or maybe my RO did in the beginning and I was still too numb from the you have cancer news to digest it properly.

I'm seeing my regular doctor Friday and will certainly ask him about this. Like you and some of the others I have occasional bouts of dizziness when standing up. I'd assumed it was because I'm still underweight and also fairly tall, and have always had low blood pressure. Now I'm wondering if carotid stenosis is playing into it.

Thanks for the well-written analogy, and in general for all that you do for us.

Glad I found this discussion. Hubbie is going in for more radiation 6 months after his last treatment. This time the Doctor feels he removed all the cancer after his radical neck dissection but would like to clean up any microscopic cells with the cyber knif. There is a 10 to 15% chance his carotid artery could rupture. I have been so nervous of this situation. He has been feeling real dizzy after sitting and then standing. I almost want to stay very close to the hospital for a while when he is going through this just incase there is an emergency.

Hi lady 22 - make sure the dr is aware of the dizziness! And good luck!