Carotid artery intervention for 90 % stenosis forty-years after radiation in a patient with squamous cell carcinoma recurrence: A case report

Head and neck cancer recurrence in previously irradiated patients presents complex surgical challenges, particularly when compounded by asymptomatic carotid artery stenosis. Radiation therapy is a known risk factor for carotid stenosis, increasing the likelihood of cerebrovascular events during surgical intervention. : We describe a 74-year-old man with a history of squamous cell carcinoma of the right tonsil treated with surgery and radiation 40 years prior, who presented with a recurrence involving the right oral cavity. Preoperative imaging revealed 90% asymptomatic stenosis of the right internal carotid artery (ICA). Carotid angioplasty without stenting was performed prior to wide surgical resection to reduce perioperative stroke risk. One month later, the patient underwent oropharyngectomy with reconstruction. Postoperative recovery was uneventful aside from minor wound complications. Final pathology showed negative margins and no nodal involvement, and no adjuvant therapy was required. Angioplasty, lithotripsy, and stenting of the right ICA was performed 11 months after the initial angioplasty due to asymptomatic restenosis. : This case illustrates the importance of screening for carotid artery stenosis in patients with prior head and neck radiation who are undergoing salvage surgery. Carotid angioplasty without stenting offers a viable preoperative strategy in select patients to mitigate cerebrovascular risk while avoiding complications associated with dual antiplatelet therapy. : Carotid angioplasty followed by resection can be safely and effectively performed in patients with recurrent head and neck cancer and radiation-induced carotid stenosis. This case underscores the need for multidisciplinary planning and vigilance in preoperative assessment.