Neck irradiation, carotid injury and its consequences

Carotid stenosis is a major sequela of head and neck irradiation that has not received the attention it deserves. Its impact on the quality of life of patients can be substantial. This review discusses the incidence, pathogenesis and consequences of radiation-induced carotid stenosis following head and neck irradiation. This review is based on literature search (Medline and Pub Med) and cross-referencing. The incidence of significant carotid stenosis following head and neck irradiation range from 30% to 50%. Patients with carotid stenosis are at increased risk for stroke. Factors such as hypertension, diabetes, smoking and obesity increase the risk. Increased attention to the clinical signs of carotid stenosis and evaluation of these patients with appropriate imaging studies, together with strict implementation of management of hypertension and diabetes and, counseling on obesity and smoking have the potential to reduce the incidence of this sequela of head and neck irradiation. Those patients with severe carotid stenosis can be managed with endarterectomy or carotid artery stenting.