Carotid angioplasty and stenting (CAS) is being promoted for patients with
carotid artery stenosis who have received neck irradiation. We reviewed our
experience with carotid endarterectomy (CEA) following neck irradiation to
determine if indeed postoperative and long-term problems were an issue in
these patients. Over the past 13 years, 10 patients with a history of neck
irradiation underwent 11 procedures. The average time interval between radi
ation treatment and surgery was 14 years (range 1-44). All carotid arteries
were repaired with a standard endarterectomy, eight of which were patched.
Three patients had undergone a radical neck dissection on the side ipsilat
eral to the carotid lesion. They received a pectoral myocutaneous flap (PMF
) to protect the carotid artery and optimize wound healing. The lack of per
ioperative complications and of morbidity indicate that carotid reconstruct
ion for patients with previous neck irradiation is safe and durable. Until
long-term favorable results with CAS are available for these patients, oper
ative intervention should remain the standard treatment.