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Carotid stenting for radiation-induced carotid artery stenosis: a challenge?

Endovascular treatment of radiation-induced carotid lesions is challenging and very demanding from a technical standpoint. The authors report the case of a 48-year-old male patient who presented in the emergency department with a non-ST elevation acute coronary syndrome. He had a past history of lung carcinoma treated with radiotherapy. Diagnostic workup included coronary angiography (showing predominantly ostial coronary artery disease) and carotid angiography, which showed a long ulcerated lesion in the right carotid artery. Carotid angioplasty was performed using distal cerebral embolic protection. The post-procedure course was uneventful. At 24 months the patient is well and no major adverse cardiovascular events have been reported. The case presented demonstrates that carotid artery stenting can be safely performed in high risk lesions and highlights the importance of stenting technique and of thorough follow-up.