Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management

Patients undergoing radiotherapy (RT) for head and neck cancers (HNCs) face a significantly increased risk of developing carotid artery stenosis (CAS) and cerebrovascular disease (CVD). This condition, known as accelerated or radiation-induced carotid atherosclerosis, represents a long-term toxicity that profoundly impacts patients’ quality of life and survival. Pathogenesis is complex, involving mechanisms such as direct endothelial damage, oxidative stress, chronic inflammatory activation, peri-adventitial fibrosis, and the acceleration of pre-existing atherosclerotic processes. Despite this elevated risk, universal screening and treatment are not yet standardized across all international guidelines. This narrative review summarizes the epidemiology, pathological mechanisms, and clinical implications of accelerated radiation-induced carotid stenosis (RICS) after neck irradiation.