Longitudinal assessment of carotid atherosclerosis after Radiation Therapy using Computed Tomography: A case control Study.

OBJECTIVES: To study the carotid artery plaque composition and its volume changes in a group of patients at baseline and 2 years after head and neck radiation therapy treatment (HNXRT). METHODS: In this retrospective study, 62 patients (41 males; mean age 63 years; range 52-81) who underwent HNXRT and 40 patients (24 males; mean age 65) who underwent surgical resection of neoplasm and did not undergo HNXRT were assessed, with 2-year follow-up. The carotid artery plaque volumes, as well as the volume of the sub-components (fatty-mixed-calcified), were semiautomatically quantified. Mann-Whitney and Wilcoxon tests were used to test the hypothesis. RESULTS: In the HNXRT group, there was a statistically significant increase in the total volume of the carotid artery plaques (from 533 to 746 mm(3); p = 0.001), in the fatty plaques (103 vs. 202 mm(3); p = 0.001) and mixed plaque component volume (328 vs. 419 mm(3); p = 0.034). A statistically significant variation (from 21.8 % to 27.6 %) in the percentage of the fatty tissue was found. CONCLUSIONS: Results of this preliminary study suggest that HNXRT promotes increased carotid artery plaque volume, particularly the fatty plaque component. KEY POINTS: HNXRT increases carotid plaque volume. Plaque volume increase is mainly due to increase.in fatty plaque component. Patients who undergo HNXRT have a progression of carotid artery disease.

Beta radiation and inhibition of recanalization after coil embolization of canine arteries and experimental aneurysms: how should radiation be delivered?

BACKGROUND AND PURPOSE: Beta radiation prevents recanalization after coil embolization. We sought to determine the effects of varying coil caliber, length, activity of 32P per centimeter of coil or per volume, and spatial distribution of coils on recanalization. METHODS: We studied the angiographic evolution of 81 canine maxillary, cervical, and vertebral arteries implanted with a variety of nonradioactive (n=29 arteries) or radioactive (n=52) devices. We compared 1- or 2-caliber 0.015 or 0.010 coils ion-implanted or not with 3 different activity levels (0.05 to 0.08, 0.06 to 0.12, 0.18 to 0.32 microCi/cm) of 32P and totaling 4, 8, and 16 cm in length for the same arterial volume. We also compared inhibition of recanalization by beta radiation delivered by stents, after coil occlusion proximal to or within the stent, with that delivered by coils placed within nonradioactive stents. We finally studied the angiographic evolution of canine lateral wall carotid aneurysms treated with 1 or 2 stents of various activity levels positioned inside the parent artery across the neck. Animals were killed at 4 and 12 weeks for macroscopic photography and pathological examination. RESULTS: All arteries (29 of 29) occluded with nonradioactive devices were recanalized, while 49 of 52 arteries (94%) implanted with 32P devices were occluded at 4 weeks. All aneurysms treated with stents, radioactive or not, demonstrated residual filling of the sac or of channels leading to the aneurysms at follow-up angiography at 4 weeks. CONCLUSIONS: The recanalization process found in the canine arterial occlusion model is minimally affected by coil caliber, number, and length or packing density. Beta radiation reliably inhibits this process, but thrombosis is an essential condition for the efficacy of a radioactive coil strategy.

Management of advanced cervical metastasis using intraoperative radiotherapy.

Seventy-five patients who had advanced cervical metastasis with possible invasion of the deep muscles or carotid artery were approached with aggressive resection and intraoperative radiotherapy (IORT). All metastatic nodes were greater than 3 cm, 65% were fixed on clinical examination, and 35% involved the carotid artery. Forty-six (61%) of the patients had previously received irradiation. Fifteen of the patients required extended neck dissections with carotid resections and grafting. After the resection an average single dose of 2000 cGy of electron beam IORT was delivered. At 2 years, the local control rate within the IORT port was 68% and the absolute survival rate was 45%. Local control rates for close and microscopic margins (76% and 73%, respectively) were significantly better than the control rate for gross residual disease (25%, P < .05). The combination of extended neck dissection, including carotid artery resection if necessary, and IORT appears to offer improved control.

Irradiation of spontaneous carotid-cavernous fistulas.

Two patients with spontaneous carotid-cavernous fistulas were successfully treated with cobalt 60 irradiation to the sellar region. Angiographically, one patient showed combined-type shunts comprising a dural internal carotid-cavernous fistula and a direct internal carotid-cavernous fistula; the other patient had a mixed dural external and internal carotid-cavernous fistula. The respective total radiation dose was 3,200 rads and 3,024 rads. The patients responded satisfactorily to the treatment, with disappearance of the fistulas on angiograms and patency of the internal and external carotid arteries.

Use of intraoperative 125iodine implants for large tumors attached to the carotid artery.

Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection with preservation of the artery, and intraoperative 125Iodine implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With the minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastasis occurred in 45%. Mean survival was 15 months in the primary group (range, 2-50 months) and 12 months in the recurrent group (range, 4-26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

[Branchial paraganglioma. A case of carotid paraganglioma and review of the literature]. / Les paragangliomes branchiaux. A propos d'un cas de paragangliome carotidien et revue de la littérature.

We report the case of a 58-year-old man hospitalized for generalized seizures. A grade II glioma of the left frontotemporal region was diagnosed on brain CT scan and stereotaxic biopsy results. Radiotherapy was successful in treating this glioma. A glomus tumor of the left carotid was discovered by duplex Doppler examination of the carotid and confirmed on arteriography. Resection was performed to the adventitia. Branchial glomus tumors are rare, often benign tumors. The carotid is a common localization. Surgery is often indicated due to the risk of local invasion. Surgical procedure varies according to the size and localization of the tumor. This case demonstrates that glomus tumor of the carotid can coexist with a frontotemporal glioma.

[Carotid-cavernous fistula successfully treated with embolization and radiation therapy: report of three cases].

Three cases of mixed internal and external carotid-cavernous fistula (CCF) were successfully treated with embolization of feeders from the external carotid artery (ECA) and focal irradiation to the cavernous sinus (CS). Cases 1 and 2 were females, 63 and 69 years old respectively, both with spontaneous left CCF. Case 3 was a 55 year old male with posttraumatic left CCF. Symptoms of case 1 were double vision, left chemosis and exophthalmos; those of case 2 were double vision, left retroobital pain, left forehead dysesthesia and blurred vision; and case 3 complained of double vision, left chemosis, left exophthalmos and pulsatile tinnitus. In all three cases, angiography disclosed left CCF fed by ipsilateral dural branches from the internal maxillary artery (IMA) and the internal carotid artery (ICA). In case 1, small branches from the ascending pharyngeal artery also fed the CS. In cases 2 and 3, feeders from the ECA were arising only from branches of the IMA. In case 3, hypertrophy of the meningohypophyseal trunk was visible. In cases 1 and 2, although the CS was opacified, feeders from the ICA were not clearly visible. Embolizations of branches of the IMA were performed in all cases using Ivalon under selective catheterization. In case 1, symptoms partially improved, but in cases 2 and 3, visual symptoms were transiently aggravated. Focal irradiation to the CS was done with total doses of 30, 30 and 40 Gy each for cases 1, 2, and 3 respectively. In case 1, clinical symptoms gradually improved about one third way through irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of spontaneous carotid-cavernous fistula disappearing following irradiation].

A case of spontaneous carotid-cavernous fistula, which completely disappeared following irradiation (45 Gy), is reported. A 59-year-old woman was admitted on October 10, 1983, with a history of doplopia and recurrent retrobulbar and occipital pain. On admission, neurological examination showed no neurological deficit, and right cerebral angiography demonstrated a dural internal carotid-cavernous fistula fed by the meningohypophyseal trunk and drained into the inferior petrosal sinus. In spite of the conservative management, right oculomotor palsy and hypesthesia corresponding to the division of ophthalmic branch of the right trigeminal nerve was developed. On November 22, liniac irradiation to the region of fistula (30 days, total dose, 45 Gy) was started. Symptoms and signs gradually improved 3 weeks after irradiation and completely disappeared 3 months after irradiation. Carotid-cavernous fistula was no longer demonstrated by the cerebral angiography 7 months after irradiation. Two years after onset, no recurrence of symptoms was observed.

[Successful radiotherapy in spontaneous carotid-cavernous sinus fistula--a case report].

The authors reported a case of spontaneous carotid-cavernous sinus fistula fed by meningohypophyseal trunk of the internal carotid artery, that completely disappeared following cobalt 60 irradiation to the region of fistula (27 days; total dose, 4,100 rad). A 65-year-old man was admitted to our hospital on May 25, 1982, with a two-week history of progressive prominence of the left eye, diplopia on left lateral gaze, and continuous intracranial bruit. He first noted redness of the left eye without apparent cause such as head trauma. On admission, slight nonpulsative exophthalmos, periorbital edema, chemosis, and venous congestion of the conjunctiva of the left eye were noted. The pupils were reactive and equal in size, and the left abducent nerve palsy was observed. Fundoscopic examination disclosed to be normal. No bruit was heard over the left orbital region. Left carotid angiography on May 28 demonstrated dural internal carotid-cavernous sinus fistula fed by meningohypophyseal trunk, and drained into superior and inferior ophthalmic veins and basilar venous plexus. Though the patient was treated only conservatively, symptoms became worse to decrease visual acuity. On July 14, we started cobalt 60 irradiation to the region of fistula (27 days; total dose 4,100 rad). Symptoms gradually improved about halfway through irradiation. After completion of irradiation, almost complete improvement of visual and ocular symptoms was observed except the left abducent nerve palsy. Repeated angiography on Aug. 20 revealed complete disappearance of fistula. Three months after treatment, no recurrence of symptoms was observed and the abducent nerve palsy persisted without improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of ultrasonic dopplerography in monitoring the effectiveness of treatment of patients who have sustained a stroke with decimeter-range electromagnetic waves]. / Znachenie ul'trazvukovoi dopplerografii v kontrole za éffektivnost'iu lecheniia élektromagnitnymi volnami detsimetrovogo diapazona bol'nykh, perenesshikh mozgovoi insul't.

The data on the high therapeutic efficiency of the local use of decimeter electromagnetic waves (DEMW) in stroke survivors are presented (a course of therapy consisted of 10-12 procedures). Doppler sonography proved to be a highly effective method of monitoring the treatment results. The technique makes it possible to ascertain some aspects of the mechanism of DEMW therapeutic action and provides the researcher with complete information on the intensity and the rate of the collateral circulation development.

Endoluminal carotid stenting prior to photodynamic therapy to pericarotid malignant disease: technical advance.

We present a technical note which reduces the occurrence of carotid artery rupture during the treatment of peri-carotid disease. The use of radiologically inserted endoluminal carotid stenting prior to photodynamic therapy provides vessel protection.

[Proton irradiation of spontaneous arterio-sinus anastomoses in the cavernous sinus region]. / Protonnoe obluchenie spontannykh arteriosinusnykh soustii oblasti kavernoznogo sinusa.

Altogether 10 patients with spontaneous arteriosinusal anastomoses in the cavernous sinus area have been irradiated at the N. N. Burdenko Institute of Neurosurgery, USSR AMS. since 1983 using the synchrotron of the Institute of Theoretical and Experimental Physics. A "piercing" method with a proton beam of 12 mm in diameter (in one case 10 mm) was employed. Nine patients had unilateral anastomoses with the blood supply from branches of the internal and/or external carotid arteries, and one patient had a bilateral anastomosis. Irradiation was given in 2 fractions, in 2-3 days, the maximum total dose was 50-60 Gy. Regression of ophthalmological symptoms was noted 2-3 months after irradiation. Convalescence was noted in 8 patients, a follow-up period in 2 patients was insufficient. Of 7 patients examined by angiography complete thrombosis of the anastomosis was noted in 4, considerable reduction of the blood flow was noted in 3.

Treatment of type D dural carotid-cavernous fistula by embolization followed by irradiation.

In a patient with dural carotid-cavernous fistula supplied by meningeal branches of both internal and external carotid arteries, particulate embolization of the meningeal branches of only the external carotid artery failed to cure the fistula. Subsequent radiation therapy achieved clinical and anatomical cure of the lesion.

Cervical synovial sarcoma at the bifurcation of the carotid artery.

Cervical synovial sarcoma has been reported in only 15 cases; in none of these was there any association with a vascular structure. A patient with cervical synovial sarcoma encompassing the bifurcation of the left carotid artery underwent a left radical neck dissection, including excision of the left external carotid artery and the hypoglossal nerve. The tumor was dissected away from the common carotid and internal carotid arteries. Although the fibrous pseudocapsule of the tumor had not involved the fibrous adventitia of the carotid arteries. Radiation therapy with 6000 rads tumor dose was administered to a wide local field. There is no evidence of recurrence 1 year postoperatively. Histologic and ultrastructural findings were similar to those reported previously in a case of synovial sarcoma of an extremity.

Type D dural carotid-cavernous fistula. Results of combined treatment with irradiation and particulate embolization.

PURPOSE: To assess the efficacy of irradiation combined with particulate embolization for treating type D dural carotid-cavernous fistulas, supplied by the meningeal branches of both external (ECA) and internal carotid arteries. MATERIAL AND METHODS: Nine patients were treated by particulate embolization via the ECA branches, followed by radiation therapy with doses of 30 Gy. One of these patients with recurrent symptoms received an additional 30 Gy one year after initial treatment, making a total dose of 60 Gy. RESULTS: In all cases, symptoms were improved immediately after the particulate embolizations. In 8 cases, complete resolution of symptoms were obtained in 4-19 months and an average of 8 months after treatment. In one case, chemosis was markedly improved and persisted minimally 41 months later. CONCLUSION: Particulate embolization is effective for immediate symptomatic improvement, and complete resolution of symptoms can usually be achieved by subsequent radiation therapy.

Effects of postoperative external beam irradiation after carotid artery stripping of nodal metastasis.

PURPOSE: The objective of this study was to determine the effects of postoperative external beam irradiation (PEBI) on patients after stripping the carotid vessel of nodal metastasis. PATIENTS AND METHODS: Of 245 patients who underwent radical neck dissection for cancer of the upper aerodigestive tract between 1981 and 1995, 13 patients with nodal metastasis adherent to the carotid artery (NMCA) received a full course of PEBI after the tumor was peeled off the carotid vessel. Patterns of treatment failure, survival, and serious morbidity were evaluated. RESULTS: At the time of last follow-up (range, 3 to 125 months), fewer than half of the patients (46%) were free of disease, and two patients (15%) had developed distant metastases. The estimated 2-year survival rate was 23%. There were no intraoperative, postoperative, or post-radiation therapy complications. CONCLUSION: PEBI after carotid artery stripping of tumor can achieve locoregional disease control in select patients without an increased risk of vessel rupture. However, if the prognosis for patients with NMCA is to improve, other effective management strategies need to be investigated.