Contrast-Enhanced Vessel Wall Imaging in Determining Angioplasty Suitability for Radiation-Induced Stenosis: A Case...

Radiotherapy is a recognized risk factor for vascular stenosis in patients with head and neck cancer. However, the treatment for radiation-induced vascular stenosis remains undefined because of its distinct pathophysiology from that of atherosclerotic disease. Herein, we present a case of radiation-induced stenosis successfully treated with balloon dilatation, guided by the assessment of vessel wall thickness using contrast-enhanced vessel wall imaging (CE-VWI). A 49-year-old woman presented with transient left hemiparesis at an outpatient clinic. The patient had a right cavernous sinus meningioma and had undergone tumor resection followed by radiotherapy for residual tumor 2 years earlier. Magnetic resonance imaging revealed right cerebral infarction caused by severe stenosis of the right middle cerebral artery, leading to a diagnosis of radiation-induced vasculopathy. Percutaneous transluminal angioplasty was planned after CE-VWI demonstrated significant wall thickening at the stenosis site. The procedure resulted in clinical improvement, and the patient remained recurrence-free during follow-up. CE-VWI is a valuable tool for assessing vessel wall integrity and for determining the feasibility of angioplasty in patients with radiation-induced vascular stenosis.