Clinical features and CTA imaging of radiation-induced carotid pseudoaneurysms in nasopharyngeal carcinoma

To investigate the clinical characteristics and CTA imaging features of radiation-induced carotid artery pseudoaneurysm (CAPA) in patients with nasopharyngeal carcinoma (NPC). We retrospectively analyzed 22 NPC patients with CAPA confirmed by DSA after radiotherapy. Clinical data and CTA findings were reviewed. All patients presented with anemia; 81.8% experienced massive epistaxis. CAPAs were predominantly solitary (90.9%) and located in the internal carotid artery, especially the C3 segment. CTA revealed pseudoaneurysm morphology, adjacent tissue necrosis, osteoradionecrosis, and parent artery stenosis. The rebleeding rate within 3 months was 31.8%, and the mortality rate was 18.2%. Low BMI were associated with worse outcomes. CAPA is a life-threatening but detectable complication in post-radiotherapy NPC patients. CTA facilitates early identification of vascular injury and supports timely intervention planning; however, despite timely detection and endovascular treatment, the short-term prognosis of CAPA remains poor.