External carotid artery stenosis in patients with head and neck squamous cell carcinoma--a prospective study

Vascular disease, which can be asymptomatic until arterial stenosis is severe, is common in head and neck cancer patients as the risk factors for both cancer and atherosclerosis are similar. Although studies of common and internal carotid artery stenosis in head and neck patients have been reported, none have specifically assessed the external carotid system, especially in asymptomatic patients undergoing major microvascular free flap reconstructive surgery. A prospective study of 44 patients using pre-operative duplex scanning to assess the common, external and internal carotid arteries bilaterally. Eighteen patients (41%) had no obvious carotid disease in any vessel. Although the remaining 26 patients (59%) had some carotid tree stenosis, only nine patients (20% of study group) had disease affecting the external carotid artery, with significant stenosis (greater than 50%) of this vessel being found in only three patients (7%). A correlation was found between the degree of carotid stenosis and hypertension (P<0.05). No correlation was found between carotid artery stenosis and flap failure (t=5.4; P=1). Significant stenosis of the external carotid artery, even in the presence of atherosclerosis elsewhere in the carotid tree, is uncommon. The screening of the external carotid artery in head and neck patients requiring microvascular reconstruction should be considered when there are significant risk factors for carotid stenosis, including hypertension.