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Radiation Vasculopathy.

Hui Meng Chang1, Narayanaswamy Venketasubramanian2

  • 1Department of Neurology, National Neuroscience Institute - Singapore General Hospital Campus, Singapore, Singapore.

Cerebrovascular Diseases Extra
|June 1, 2025
PubMed
Summary
This summary is machine-generated.

Radiation exposure accelerates atherosclerosis in extracranial arteries, increasing stroke risk. This occurs early after treatment, regardless of traditional risk factors, and can lead to serious complications like carotid blowout.

Keywords:
RadiationStrokeVasculopathy

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Area of Science:

  • Neurology
  • Oncology
  • Vascular Surgery

Background:

  • Cerebrovascular radiation-related vasculopathies affect all vessel sizes.
  • Extracranial carotid and vertebral artery (VA) radiation-induced atherosclerosis is common in Asia due to high rates of oro-nasopharyngeal cancers treated with radiation therapy (RT).

Purpose of the Study:

  • To summarize the characteristics and complications of cerebrovascular radiation vasculopathies, particularly in the Asian population.
  • To highlight the accelerated development of atherosclerosis and increased stroke risk following radiation exposure.

Main Methods:

  • Retrospective studies using carotid intima media thickness measurements.
  • Analysis of plaque characteristics and risk factors.
  • Review of treatment outcomes for complications like carotid blowout.

Main Results:

  • Radiation exposure induces early and rapid atherosclerosis, with significant changes seen as early as 1 year post-RT.
  • A fourfold increased risk of accelerated plaque development compared to non-radiated individuals, irrespective of traditional risk factors.
  • Radiation-induced plaques often exhibit high-risk features, increasing the risk of ischemic and hemorrhagic strokes, particularly in patients under 40.

Conclusions:

  • Radiation exposure significantly accelerates atherosclerosis in extracranial arteries, leading to increased stroke risk and potential complications like carotid blowout syndrome.
  • Treatment of radiation-induced carotid artery disease may favor stenting over endarterectomy due to a 'hostile neck' environment.
  • While less common in Asian populations, other radiation-related vasculopathies include intracranial aneurysms with long latency periods.