Radiation-Induced Carotid Artery Stenosis Following Head and Neck Cancer Treatment

Abstract

This case report presents a 68-year-old female with a complex medical history including metastatic squamous cell carcinoma of unknown primary site, treated with excisional biopsy and definitive chemoradiotherapy (CRT), and surgically treated stage 0 cervix cancer. The patient displayed the presentation of severe proximal right internal carotid artery (ICA) stenosis, picked up during a carotid duplex examination. Patient has history of squamous cell carcinoma with unknown primary and metastasis to left cervical lymph nodes for which treatment was given from January to March 2014. The case presents a noteworthy instance of a patient developing clinically significant carotid artery stenosis 9 years post-radiotherapy, despite having normal duplex ultrasound findings just 3 years prior to diagnosis. The rapid progression of the stenosis underscores the potential long-term vascular risks associated with head and neck radiotherapy, even in patients without traditional cardiovascular risk factors. The clinical course includes comprehensive treatment for squamous cell carcinoma involving the lymph nodes of the head and neck region, including Chemoradiotherapy and concurrent Cisplatin chemotherapy. A normal result was obtained from a routine duplex ultrasound in 2020; however, finding stenosis was quite surprising. As per the CTA done in 2023, the right ICA occlusion was severe, and the left common carotid artery stenosis was mild to moderate. Such a massive shift over such a short duration brought out the competitive tone of the stenosis. Diagnostic findings reveal new severe proximal right ICA stenosis compared to prior assessments. This case highlights the importance of continued monitoring of long-term vascular complications post management of patients who have undergone chemoradiation.