Radiotherapy as a Contributing Factor to Carotid Vasculopathy Leading to Tandem Internal Carotid-Middle Cerebral Artery Occlusion Stroke

TL;DR

A man who had high-dose radiotherapy for throat cancer later suffered a stroke linked to radiation-induced carotid artery damage.

Contribution

This case highlights radiotherapy as a potential cause of delayed large-vessel stroke and the effectiveness of thrombectomy in such cases.

Findings

Radiotherapy may contribute to accelerated carotid vasculopathy and stroke years later.

Mechanical thrombectomy with carotid stenting successfully treated radiation-associated tandem vessel occlusion.

Long-term vascular surveillance is crucial for cancer survivors who received high-dose neck radiotherapy.

Abstract

A 64-year-old man with a history of p16-positive oropharyngeal squamous cell carcinoma treated with high-dose bilateral radiotherapy in 2017 presented with sudden-onset left-sided weakness, dysphasia, and homonymous hemianopia. Initial computed tomography and computed tomography angiography demonstrated complete right internal carotid artery (ICA) occlusion with a tandem right middle cerebral artery (M1) thrombus. Magnetic resonance imaging confirmed multiple acute infarctions within the right middle cerebral artery territory and watershed zones. He underwent urgent mechanical thrombectomy with angioplasty and stenting of the right ICA, achieving successful reperfusion. His medical history included hypertension, hypothyroidism, and previous smoking. This case highlights radiotherapy as a contributing factor to accelerated carotid vasculopathy and delayed large-vessel ischaemic stroke. It underscores the importance of long-term vascular surveillance in cancer survivors who previously received high-dose neck radiotherapy and demonstrates that mechanical thrombectomy with carotid stenting is a feasible treatment strategy in radiation-associated tandem vessel occlusion.

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