Balloon-mounted stents for cervical carotid stenosis in the setting of post radiation fibrosis: A case report

Radiation therapy for head and neck cancers is a known risk factor for carotid artery stenosis due to radiation-induced vascular injury and fibrosis. While carotid endarterectomy (CEA) remains the standard treatment, carotid artery stenting (CAS) is often preferred in patients with prior neck irradiation due to lower perioperative risks. However, the use of balloon-mounted stents in this context remains underreported. This case describes a patient with a history of squamous cell carcinoma treated with neck radiotherapy, who developed severe restenosis at the proximal end of a previously placed self-expanding stent in the left common carotid artery. Given the focal nature of the lesion, minimal vessel tortuosity, and the presence of post-radiation fibrosis, a balloon-mounted stent was selected for precise deployment. The procedure was successful, and the patient was discharged without complications. Balloon-mounted stents may offer technical advantages over self-expanding stents in select cases of radiation-induced carotid stenosis, particularly in short, focal lesions with relatively straight anatomy. This case contributes to the limited literature on the use of balloon-mounted stents in the setting of post-radiation vascular changes.