Radiation-induced arteriopathy of internal carotid artery — a rare cause of ischemic stroke

Radiation-induced injury of the internal carotid artery (ICA) is a late complication of radiation therapy administered for neck malignancies. It manifests 5–10 years after radiation therapy as progressive atherosclerotic stenosis of the ICA. Vertebral artery involvement is not characteristic. This report describes a patient who received radiation therapy for laryngeal cancer at age 18, developed transient ischemic attack after 7 years, and experienced an ischemic stroke in the left middle cerebral artery territory 8 years post-treatment. Examination revealed left ICA occlusion and right ICA stenosis that progressed over 2 years without statin therapy. The patient condition remained stable for 13 years, no control examination of the neck arteries was performed. Absence of transient ischemic attack or stroke during this period suggests that vertebral arteries, which provide cerebral blood flow in severe ICA lesions, remain unaffected by the pathological process. This phenomenon is likely attributable to their anatomical course within the bony canal, providing protection from radiation damage.