Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management

Patients undergoing radiotherapy (RT) for head and neck cancers (HNCs) face a significantly increased risk of developing carotid artery stenosis (CAS) and cerebrovascular disease (CVD). This condition, known as accelerated or radiation-induced carotid atherosclerosis, represents a long-term toxicity that profoundly impacts patients' quality of life and survival. Pathogenesis is complex, involving mechanisms such as direct endothelial damage, oxidative stress, chronic inflammatory activation, peri-adventitial fibrosis, and the acceleration of pre-existing atherosclerotic processes. Despite this elevated risk, universal screening and treatment are not yet standardized across all international guidelines. This narrative review summarizes the epidemiology, pathological mechanisms, and clinical implications of accelerated radiation-induced carotid stenosis (RICS) after neck irradiation.

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Publication Details

Journal
Diagnostics
Published
2026-03-12
DOI
https://doi.org/10.3390/diagnostics16060841
Primary Topic
Cerebrovascular and Carotid Artery Diseases
Type
article
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article

Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management

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Cerebrovascular and Carotid Artery Diseases
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Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management

Federica Ilardi, Giovanni Benfari, Simona Sperlongano, Giulia Elena Mandoli, Giuseppe Giugliano, Maria Concetta Pastore, Alessandro Malagoli, Anna Chiara Maratea, Adriana Correra, Vincenzo Russo, Matteo Lisi, Antonello D’Andrea, Alfredo Mauriello, Matteo Cameli
article en

Abstract

Patients undergoing radiotherapy (RT) for head and neck cancers (HNCs) face a significantly increased risk of developing carotid artery stenosis (CAS) and cerebrovascular disease (CVD). This condition, known as accelerated or radiation-induced carotid atherosclerosis, represents a long-term toxicity that profoundly impacts patients' quality of life and survival. Pathogenesis is complex, involving mechanisms such as direct endothelial damage, oxidative stress, chronic inflammatory activation, peri-adventitial fibrosis, and the acceleration of pre-existing atherosclerotic processes. Despite this elevated risk, universal screening and treatment are not yet standardized across all international guidelines. This narrative review summarizes the epidemiology, pathological mechanisms, and clinical implications of accelerated radiation-induced carotid stenosis (RICS) after neck irradiation.

DiagnosticsVol. 16(6)
University of Siena (IT), University of Verona (IT), Ospedali Riuniti di Foggia (IT), Ospedale "Santa Maria delle Croci" di Ravenna (IT), Istituto Nazionale di Fisica Nucleare, Sezione di Napoli (IT), Federico II University Hospital (IT), University of Campania "Luigi Vanvitelli" (IT), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Ospedali Riuniti Umberto I (IT), National Operating Committee on Standards for Athletic Equipment (US)
Good health and well-being
Openalex Percentile: Top 25%
Cerebrovascular and Carotid Artery Diseases
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