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 Printable version |
Revascularisation of post-irradiation carotid artery stenosis |
Sang Thrombose Vaisseaux. Volume 14, Number 6, 354-61, Juin - Juillet 2002, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Olivier Chataigner, Yves Castier, Fadi Francis, Guy Lesèche |
Summary : The commonest carotid artery lesions observed after cervical or mediastinal irradiation are steno-occlusive. The increasing incidence of ENT cancers, the treatment of which is essentially by radiotherapy alone or associated with surgery, explain the rising number of "radio-induced" carotid lesions. The histopathological effects of radiation on the arterial wall are an acceleration of atherosclerosis and secondary ischaemic lesions due to radio-induced occlusion of the vasa vasorum. Irradiation acts in synergy with other sources of arterial aggression such as hyperlipidaemia, hypertension, and smoking. The diagnosis and evaluation of carotid stenosis are based on echo-Doppler ultrasonography and MRI angiography. The imputability of ionising radiation is retained on a series of arguments, none of which is specific, and remains very theoretical because of the common intrication of preexisting atheromatous disease. Arteriography of the supraaortic vessels is essential for the management of these patients because of the multifocal and extensive nature of the lesions. A previous history of irradiation increases the risk of usually transient cranial nerve paralysis and of cervical wound healing. Nevertheless, the incidence of morbi-mortality reported in series of carotid artery surgery for post-irradiation lesions, conforms to expert recommendations. Angioplasty and stenting probably have a role to plays in the management of these patients. Prospective studies are required to determine its place with respect to conventional surgery which remains the reference treatment at present. |
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