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

• Published in: Surgical neurology 2001-06, Vol.55 (6), p.347-352
• Main Authors: Koenigsberg, R A, Grandinetti, L M, Freeman, L P, McCormick, D, Tsai, F
• Format: Article
• Language: English
• Subjects: Aged; Aneurysm - diagnostic imaging; Aneurysm - etiology; Aneurysm - surgery; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - etiology; Carotid Artery Diseases - surgery; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - radiation effects; Carotid Artery, Common - surgery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - etiology; Carotid Stenosis - surgery; Cerebral Angiography; Humans; Laryngeal Neoplasms - radiotherapy; Male; Neurosurgical Procedures - methods; Radiotherapy - adverse effects; Stents; Treatment Outcome; Vascular Surgical Procedures - methods
• ISSN: 0090-3019
• DOI: 10.1016/s0090-3019(01)00476-1

Radiation-induced damage to small and medium-sized vessels has been observed in both animals and humans. Changes may appear in the immediate postradiation period or many years later. In this case, we report an unusual presentation of bilateral radiation-induced carotid artery stenoses associated with pseudoaneurysms, and a previously unreported application of a recently established treatment. A 72-year-old African-American male presented with recurrent right hemispheric transient ischemic attacks (TIA) and neck pain. Thirteen years previously, the patient had received radiation therapy for laryngeal carcinoma. Diagnostic carotid angiography demonstrated moderate radiation-induced bilateral carotid artery stenosis and associated common carotid pseudoaneurysms. The patient was treated with bilateral endovascular stents and electrolytically detachable coils in staged procedures. At his most recent follow-up, there is no evidence of re-stenosis and the patient remains asymptomatic. This case illustrates a novel and successful treatment for the endovascular repair of post-radiation bilateral carotid artery stenosis and pseudoaneurysms. In our practice, we have seen three such cases of radiation-induced vasculopathy. Therefore, patients with a previous history of radiation therapy for head and neck neoplasms merit cautious monitoring and judicious use of stents and secondary coils, when necessary.