Abstract
Many articles report that the incidents of in-stent restenosis after carotid artery stenting (CAS) were higher in radiation-induced carotid stenosis. We report a case of repeated plaque protrusion after CAS for radiation-induced carotid stenosis, in a patient who received surgical treatment and adjuvant radiotherapy for neck cancer 11 years previously. The patient was a 71-year-old man who received treatment for diabetes mellitus, hypertension, and hyperlipidemia. He was diagnosed with cerebral infarction that caused right hemiplegia. Diffusion-weighted magnetic resonance imaging (MRI) revealed infarction at the frontal operculum, and cerebral angiography revealed bilateral internal carotid artery stenosis; the left side, symptomatic, showed 50% stenosis with soft plaque seen on MRI plaque imaging and the right side, asymptomatic, showed 80% stenosis with hard plaque. We chose carotid stenting instead of carotid endarterectomy for both carotid arteries because of the risks of surgery and radiation therapy. However, repeated carotid stenting and angioplasty were needed on both sides due to repeated in-stent restenosis. The incidence of ischemic stroke is significantly increased in patients receiving radiotherapy to the neck, especially in patients with risks of atherosclerotic disease. In such cases, strict observation and early intervention are thought to be important before accumulation of soft plaque due to atherosclerotic change, which may result in difficulty of treatment for carotid stenosis.
