Prevalence of carotid stenosis following radiotherapy for head and neck cancer: A systematic review and meta‐analysis

Abstract Background Radiation to the head and neck is a well‐established risk factor for the development of carotid artery stenosis. Our objective was to identify the prevalence, incidence, and degree of carotid stenosis in patients with a history of head and neck irradiation. Methods This study was performed according to the PRISMA guidelines. A random effects model meta‐analysis was conducted. Results Nineteen studies comprising 1479 patients were included. The prevalence of carotid stenosis >50%, >70%, and carotid occlusion was 25% (95% CI: 19%‐32%), 12% (95% CI: 7%‐17%), and 4% (95% CI: 2%‐8%), respectively. The cumulative 12‐month incidence of carotid stenosis >50% was 4% (95% CI: 2%‐5%), the 24‐month was 12% (95% CI: 9%‐15%), and the 36‐month was 21% (95% CI: 9%‐36%). Conclusions The yearly incidence of carotid stenosis >50% increased every year during the first 3 years following radiotherapy. We propose routine yearly Doppler ultrasound screening beginning 1 year after head and neck radiotherapy.