Endovascular treatment for carotid stenosis developing after neck radiotherapy

Aims: One of the causes of carotid stenosis is radiation therapy to the neck area. Cervical irradiation is frequently used in the treatment of head and neck cancers. However; the ionizing effect of radiation causes arteritis, which can lead to acceleration of fibrosis or atherosclerosis, thrombosis, stenosis, or occlusion. Carotid stenosis due to radiation is relatively rare. Accordingly, in this study, our aim was to assess the feasibility, safety and preliminary efficacy of endovascular therapy for carotid stenosis developing after neck radiotherapy. Methods: This study was a retrospective review of a prospectively maintained database of a consecutive unselected group of symptomatic and asymptomatic patients with carotid artery stenosis developing after neck radiotherapy. Data was collected from 2017 to 2023. A total of 17 patients who developed carotid stenosis due to neck radiotherapy were included in the study. Neck irradiation was applied in 76.5% of cases due to laryngeal cancer. All statistical analysis was performed using R version 4.2.1 (The R Foundation for Statistical Computing, Vienna, Austria; https://www.r-project.org). Univariate analysis was performed using ?2 and Wilcoxon tests. Cumulative survival estimates were assessed using the life-table method. Results: One patient had a technical failure due to a difficult aortic arch. Because of the degree of stenosis (40?) was not serious in conventional angiography of 2 patients, medical follow-up was decided. 3 patients were admitted to the emergency department due to acute ischemic stroke. Endarterectomy was performed in 4 patients due to the complex structure of the aortic arch and carotid arteries for carotid artery stending. The number of patients with stenosis in the right carotid was 10, while the number of patients with stenosis in the left carotid was 7. No restenosis was observed in patients with stent placement in follow-up carotid Doppler and CT angiography performed 3 months later. Additionally, no new neurodeficit was observed in the neurological examinations 3 months later. Conclusion: This retrospective study demonstrates that endovascular treatment for carotid stenosis developing after neck radiotherapy is safe, effective and reliable.