Biphasic Progression of Radiation-Induced Carotid Stenosis: The Predictive Role of Low-Density Plaque
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: Radiation therapy (RT), a primary treatment for head and neck cancer (HNC), increases the risk of radiation-induced carotid stenosis (RICS). This study examines the progression of carotid artery total occlusion (CATO) in patients with HNC after RT, focusing on low-density plaque (LDP) as a predictor, an aspect underexplored in prior research. MATERIALS AND METHODS: A retrospective cohort study assessed 44 patients with HNC who underwent RT, using 2021 follow-up data. Carotid stenosis progression was quantified via CT scans before and after LDP detection. Patients with irregular follow-up or RT within 2 years, insufficient for long-term evaluation, were excluded. RESULTS: CATO occurred in 11 patients (25%) and 12 vessels (14.3%), with a median onset of 12.6 years (interquartile range [IQR], 7.6–22.5) after RT. The stenosis progression rate increased significantly from 0.00%/year (IQR, 0.0%–1.0%) before LDP detection to 4.7%/year (IQR, 3.4%–8.1%) afterward (P < .001), with a marked acceleration to 14.8%/year (IQR, 9.6%–24.0%) in the CATO group. Neither calcification nor age at RT was significantly associated with CATO, reinforcing LDP as a critical high-risk marker. CONCLUSIONS: This study identifies LDP as a critical predictor of accelerated RICS, proposing a novel biphasic progression model with a slow phase before LDP detection and a rapid phase thereafter. Calcification showed no significant association with RICS progression. These findings support intensified surveillance, such as annual CT scans, and timely interventions to prevent occlusion in high-risk patients.
DOI: 10.3174/ajnr.a8916
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4417001975