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Ultrasound Screenings for Carotid Artery Stenosis in Patients with Neck Irradiation (External Beam Radiation; Radiotherapy)

return to: Head and Neck Cancer Followup and Survivorship Clinic - Specifics

2-5-2024 initiated by Kara Pasker PA-C

The use of ultrasound for patients with asymptomatic carotid artery stenosis is not routinely used. The USPSTF (U.S. Preventive Services Task Force) recommends against screening for asymptomatic carotid artery stenosis in the general adult population. USPSTF concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits (USPSTF 2021).

Studies show that prior neck radiation contributes to accelerated atherosclerosis and significantly greater risk for carotid artery stenosis and cerebrovascular disease (Carpenter 2018). The NCCN Survivorship Guidelines note that carotid stenosis as a well-known late effect of radiation, but stop short of making specific screening recommendations (Randolph 2022).

A literature review by Randolph 2022 recommends ultrasound screenings for carotid artery stenosis in patients with neck radiation prior to treatment and at 1 year post treatment to optimize medical management. 

A study by Carpenter et al 2023 suggests initially screening for CAS <2 years following radiation therapy completion, then every 3 years thereafter.

References

Carpenter DJ, Mowery YM, et al. The risk of carotid stenosis in head and neck cancer patients after radiation therapy. Oral Oncol. 2018 May;80:9-15. doi:10.1016/j.oraloncology.2018.02.021

Carpenter DJ, Patel P, et al. Long-term risk of carotid stenosis and cerebrovascular disease after radiation therapy for head and neck cancer. Cancer. 2023 Oct: https://doi.org/10.1002/cncr.35089

Randolph, W, & Dains, JE. Ultrasound Evaluation of carotid Artery Intima-media Thickness: Effective early marker of Carotid Artery Disease in Adult Head and Neck Cancer patients After neck Radiation? J Adv Pract Oncol. 2022 Sept; 13(7): 683-694. doi: 10.6004/jadpro.2022.13.7.4

U.S. Preventive Services Task Force. Final Recommendation Statement. Asymptomatic Carotid Artery Stenosis: Screening. February 2021.  <accessed 2-5-2024  Recommendation: Asymptomatic Carotid Artery Stenosis: Screening | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)>