53 ATHEROSCLEROTIC CAROTID STENOSIS FOLLO WING CERVICAL IRRADIATION

Fifty-three atheromatous carotid stenosis in a previously irradiated z one were operated upon between January 1983 and December 1991. A case control (retrospective) study confirmed the reality, even within the c ontext of multiple artery atheromatous localizations, of an atypical p rofile suggestive of incrimination of the radiation : extension of the atheromatous lesions distally in the common carotid, proximally beyon d the bulb. An isolated atheromatous lesion in the common carotid is v ery suggestive of post-radiation atheroma, which also presents specifi c histologic features : peri-adventitial inflammation, adventitial and medial sclerosis. These changes are not accompanied by any particular neurologic clinical manifestations, but require frequent changes in s urgical strategy : bypass rather than endarterectomy ; the extent of t he lesions decides whether the proximal implantation of the bypass is in the lower part of the common carotid or the subclavian. Radiotherap y adds to the difficulty of dissection and provokes a slight increase in morbidity, but the long term prognosis is analogous to that of usua l atheromatous lesions with, however, the risk of atherosclerotic chan ges proximally (J Mal Vasc, 1993, 18, pp. 269-274).