Characteristics of Ischemic Stroke Secondary to Radiation-Induced Arteriopathy: A Single-Centre Brief Report

Objectives: This paper aims to assess lesion distribution and the role of other factors in the development of radiation-induced arteriopathy, in relation to the established consensus. Methods: We retrospectively evaluated 15 patients with cervical arterial stenosis and prior head or neck radiotherapy admitted for suspected cerebrovascular ischemia or acute neurological symptoms. Data collected included demographics, cardiovascular risk factors, and vascular imaging. Results: The cohort was predominantly older males, with 86.7% presenting at least one cardiovascular risk factor. Latency to ischemia ranged widely from 10 months to 26 years. Hemodynamically significant lesions and severe stenoses were most pronounced at the carotid artery bifurcation, with relative sparing of the vertebral arteries. Notably, all 7 patients with documented neoplasm laterality experienced more severe carotid artery stenosis contralaterally, resulting in ischemia contralateral to the primary malignancy in 6 patients. Conclusions: Radiation-induced arteriopathy exhibits pronounced vulnerability at the carotid bifurcation and highly variable latency, suggesting the absence of a clearly defined safe temporal window post-radiotherapy. These findings, alongside the high burden of traditional cardiovascular risk factors, support the need for long-term carotid surveillance in head and neck cancer survivors.