Endovascular repair of radiation-induced bilateral common carotid artery stenosis and pseudoaneurysms: A case report

BACKGROUND Radiation-induced damage to small and medium-sized vessels has been observe d in both animals and humans. Changes may appear in the immediate postradia tion period or many years later. In this case, we report an unusual present ation of bilateral radiation-induced carotid artery stenoses associated wit h pseudoaneurysms, and a previously unreported application of a recently es tablished treatment. CASE DESCRIPTION A 72-year-old African-American male presented with recurrent right hemisphe ric transient ischemic attacks (TIA) and neck pain. Thirteen years previous ly, the patient had received radiation therapy for laryngeal carcinoma. Dia gnostic carotid angiography demonstrated moderate radiation-induced bilater al carotid artery stenosis and associated common carotid pseudoaneurysms. T he patient was treated with bilateral endovascular stents and electrolytica lly detachable coils in staged procedures. At his most recent follow-up, th ere is no evidence of re-stenosis and the patient remains asymptomatic. CONCLUSIONS This case illustrates a novel and successful treatment for the endovascular repair of post-radiation bilateral carotid artery stenosis and pseudoaneur ysms. In our practice, we have seen three such cases of radiation-induced v asculopathy. Therefore, patients with a previous history of radiation thera py for head and neck neoplasms merit cautious monitoring and judicious use of stents and secondary coils, when necessary. (C) 2001 by Elsevier Science Inc.