Postirradiation Carotid Stenosis: Pathophysiology, Diagnostic Approaches, Endovascular Treatment, and Outcomes

Postirradiation carotid stenosis (PIRCS) has emerged as a unique and challenging subtype of carotid stenosis (CS), which threatens patients with significantly worse outcomes even after aggressive intervention. Compared with nonirradiated CS patients, PIRCS patients face a shorter in-stent restenosis-free survival time after percutaneous transluminal angioplasty and stenting. This distinct behavior of PIRCS likely stems from radiation-induced endothelial changes, accelerated atherosclerosis, and potentially increased inflammatory responses. Furthermore, atypical lesions in the carotid arteries, which often occur in tandem and unusual locations, can complicate the diagnosis and treatment planning. Consequently, understanding the unique pathophysiology and clinical presentation of PIRCS is crucial for choosing optimal treatments and improving patient outcomes in this vulnerable population. In this review, we describe the basic features and unique characteristics of PIRCS. Some potentially novel treatment approaches are also discussed.