Radiation-related Carotid Stenosis 4 Cases

Objective To study the pathogenesis, clinical manifestations, imaging features, diagnosis and treatment of radiation associated carotid stenosis. Methods The history data of 4 patients who presented brain ischemic syndromes due to prior head and neck irradiation were analysed. Results In the 4 patients, 3 were male, and their ages range from 43 to 76 years, with an average age of (63.5±14.4) years. All the 4 subjects presented an acute onset sustained neurological deficiency like hemiplegia. The original tumor was nasopharyngeal carcinoma in 3 patients and thyroid carcinoma in one patient. The during from radiotherapy to the onset of stroke was 10-30 years with an average of(22.5±9.6) years. DSA, CTA, MRA and ultrasonography provided insights to the stenosis degree with satisfactory correlations. Severe carotid stenosis were discovered in all the 4 patients, furthermore, 3 carotid arteries in 2 patients were totally occluded in CEMRA. Soft plaques were detected by CTA or B-ultrasonography in 2 patients. 3 subjects received pure medical therapy while one of them suffered repeated stroke during hospitalization. Only one patient underwent DSA+CAS, with a perfect outcome and no postprocedural complications. Conclusion Radiation was associated with severe carotid stenosis with large vulnerable plaques. Stroke due to carotid stenosis was considered as a dangerous complication of radiotherapy. Clinical doctors were imposed the responsibility to follow up the post-irradiation patients, assess their stroke risk, and discover the clinical or subclinical carotid stenosis timely. Prompt therapy either conservative or surgical should be performed in these patients to minimize the stroke risk.