Carotid Artery Occlusive Disease Following External Cervical Irradiation

Cerebrovascular insufficiency caused by atypical atherosclerotic lesions in cervical arteries more than 25 years after external cervical irradiation occurred in three patients. Symptoms were produced by cerebral embolization in one patient, impaired retinal perfusion in another, and decreased total cerebral perfusion in a third. Arterial reconstructions were successfully employed in two patients who had bilateral, ulcerative lesions of the common carotid artery. Spontaneous thrombosis of the involved arteries precluded repair in one patient. The nature and mechanism of arterial damage following irradiation is described, and previously reported cases of radiationinduced arterial injury are reviewed. Radiation-induced carotid artery disease must be considered in patients with symptoms of cerebrovascular insufficiency, who have had previous cervical irradiation. Localized occlusive lesions may be identified that are amenable to vascular surgical reconstructive techniques.