Surgical Management of Atherosclerotic Carotid Artery Stenosis after Cervical Radiation Therapy

Abstract

Carotid surgery following external cervical irradiation has not been a treatment of choice. The purpose of this retrospective study was to describe the immediate and long-term outcome in a series of 17 consecutive patients who underwent operative treatment for carotid artery stenosis after radiation therapy. From 1989 to 1997, surgical treatment of carotid artery disease was carried out in a total of 723 patients. Seventeen of these patients, 14 men and 3 women, had undergone previous external cervical irradiation; their mean age was 61.7 years. The indication for radiation therapy was ear-nose-throat cancer in 14 patients and lymphoma in 3 patients. In 10 patients, irradiation was associated with cervical surgery. The mean delay between radiation therapy and carotid artery repair was 10 years. All 17 patients were considered to be in remission at the time of carotid repair. The indication for carotid surgery was asymptomatic stenosis in 6 cases (33%) and symptomatic stenosis in 12 (67%). The procedure consisted of endarterectomy in 12 cases (67%) and venous bypass in 6 (33%). The outcome for these patients was favorable, indicating that carotid artery repair following cervical radiation therapy is safe. Results are comparable to those of procedures performed in patients with no history of cervical irradiation.