Radiation-induced carotid stenosis successfully treated with carotid endarterectomy

A 78-year-old man with a history of cervical radiation therapy for malignant lymphoma presented with disseminated cerebral infarctions in the left cerebral hemisphere. Five years before this episode, he had suffered from a right cerebral infarction due to right carotid artery stenosis with mobile plaque, and had undergone carotid artery stenting (CAS). Thereafter, despite the reinforcement of antiplatelet and anticoagulant therapy, he had experienced recurrent in- stent thrombosis and ipsilateral cerebral infarctions for more than three years. This time, we chose carotid endarterectomy (CEA) for the left stenotic lesion to remove the embolic source including mobile plaque at the carotid bifurcation. His postoperative course was uneventful, with no new neurological deficits. Radiation-induced carotid stenosis (RI-CS) used to be considered high risk for CEA, but recent reports suggest that the long- term clinical results of CAS for these lesions are inferior to those of CEA. CEA may be a promising alternative for the treatment of RI-CSs, depending on the plaque characteristics and previous surgical history involving the cervical region.