Increased Risks of Large-Artery Atherosclerosis and Brainstem Stroke in Patients With Nasopharyngeal Carcinoma

Abstract Background Information about the characteristics of stroke is crucial for improved screening, prevention, and treatment. The pattern of ischemic stroke in patients with nasopharyngeal carcinoma (NPC) is not well understood. The objective of this study is to investigate the etiology of ischemic stroke and the affected vascular territories in patients with NPC. Methods The Taiwan National Health Insurance Research Database and the Taiwan Stroke Registry were combined to identify the following 2 cohorts: patients with NPC having a subsequent stroke (NPC cohort) and patients without NPC having a stroke (non-NPC cohort). Data pertaining to the period from 2006 to 2018 were analyzed. The TOAST (Trial of ORG 10 172 in Acute Stroke Treatment) subtype of ischemic stroke and the affected vascular territories were analyzed and compared between the 2 cohorts. Results The NPC cohort comprised 277 patients, whereas the non-NPC cohort comprised 125 024 patients. The most common TOAST subtype of ischemic stroke was large-artery atherosclerosis (LAA) in the NPC cohort and small-vessel occlusion in the non-NPC cohort. The prevalence of LAA was considerably higher in the NPC cohort (41.9%) than in the non-NPC cohort (28.3%). The analysis of the affected vascular territories revealed that the incidence of brainstem stroke was significantly higher in the NPC cohort (25.4%) than in the non-NPC cohort (14.5%). Conclusions Patients with NPC tend to have increased risks of LAA and brainstem ischemic stroke. Physicians should consider sparing the vertebral and basilar arteries during definitive radiotherapy for NPC. Long-term follow-up for patients with NPC may include brain magnetic resonance imaging. This study may guide radiation oncologists in clinical decision-making.