Surgical management of atherosclerotic carotid artery stenosis after cervical radiation therapy

Carotid surgery following external cervical irradiation has not been a trea tment of choice. The purpose of this retrospective study was to describe th e immediate and long-term outcome in a series of 17 consecutive patients wh o underwent operative treatment for carotid artery stenosis after radiation therapy. From 1989 to 1997, surgical treatment of carotid artery disease w as carried out in a total of 723 patients. Seventeen of these patients, 14 men and 3 women, had undergone previous external cervical irradiation; thei r mean age was 61.7 years. The indication for radiation therapy was ear-nos e-throat cancer in 14 patients and lymphoma in 3 patients. In 10 patients, irradiation was associated with cervical surgery. The mean delay between ra diation therapy and carotid artery repair was 10 years. All 17 patients wer e considered to be in remission at the time of carotid repair. The indicati on for carotid surgery was asymptomatic stenosis in 6 cases (33%) and sympt omatic stenosis in 12 (67%). The procedure consisted of endarterectomy in 1 2 cases (67%) and venous bypass in 6 (33%). The outcome for these patients was favorable, indicating that carotid artery repair following cervical rad iation therapy is safe. Results are comparable to those of procedures perfo rmed in patients with no history of cervical irradiation.