Radiation-induced Carotid Artery Stenosis with Repeated In-stent Plaque Protrusion

Abstract

Carotid endarterectomy (CEA) for radiation-induced carotid artery stenosis (RI-CS) is considered a high-risk procedure because of its perioperative complications. Carotid artery stenting (CAS) seemingly offers an alternative treatment. However, mid- and long-term outcomes after CAS are not necessarily favorable, and several reports have indicated that CAS has a relatively higher rate of restenosis and additional treatment than those associated with CEA. Herein, we describe a case of RI-CS with repeated in-stent plaque protrusion (ISPP) after CAS. A 74-year-old man was diagnosed with RI-CS one year prior and had undergone CAS for severe stenosis of the left common carotid artery. In-stent stenosis and mobile plaque were detected one year after CAS, necessitating stent-in-stent placement. However, ISPP was repeated over a short period and required additional treatment. In conclusion, RI-CS with a large number of unstable plaques and ulcerations may cause ISPP and cerebrovascular events. Therefore, CEA should be considered as a therapeutic modality.