[Intracranial artery stenoses 44 years after craniofacial radiotherapy]

A 58 year-old patient experienced several ischemic strokes in the carotid arteries territories. History revealed a nasal epithelioma, for which he had received, at age 14, an irradiation through an anterior field (5500 rads), and two lateral fields (4550 rads each). He had a nasofacial atrophy as apparent sequellae. Angiograms showed stenoses of the cavernous portion of both internal carotid arteries and of the proximal portion of the left anterior cerebral artery. The ophthalmic arteries were narrowed and irregular. Despite the very long delay and the patient's age (that of common atherosclerosis) and the lack of specificity of the lesions, the relationship between the arterial lesions and radiotherapy was accepted: the site of the arterial lesions corresponded to that of irradiation; other carotid segments, and particularly the bifurcations of the common carotid arteries, appeared normal on angiograms. The X-rays dose delivered in the region of the Willis arterial circle had been very high. A review of the rare reported cases of intra-cranial post-irradiation arteriopathy is presented.