Radiation-Induced Carotid Artery Stenosis in Head and Neck Cancer Patients: A Comprehensive Review of Imaging Features, Pathogenesis, and Clinical Manifestations

Head and neck cancer is one of the most common malignancies in the United States. In the last decades, advances in treatment have greatly improved survival. However, as patients are living longer, late effects of treatment have been increasingly recognized. Carotid artery stenosis secondary to prior neck irradiation predisposes survivors to an increased risk of cerebrovascular events, cranial nerve deficits, and cardiovascular morbidity. Understanding the pathophysiology, imaging findings, and clinical course of radiation-induced steno-occlusive disease of the cervical carotid artery is crucial for radiologists to understand and accurately interpret imaging examinations of such patients. In addition, this review outlines the epidemiologic risk factors, clinical and radiologic features, and recommended treatment modalities for patients with prior irradiation of the head and neck. By consolidating the current evidence, we aim to underscore the clinical significance of this complication and highlight the importance of long-term surveillance and tailored management of RICS among head and neck cancer survivors.