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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.<\/jats:p>","DOI":"10.3390\/diagnostics16060841","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T14:46:31Z","timestamp":1773326791000},"page":"841","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7060-6938","authenticated-orcid":false,"given":"Alfredo","family":"Mauriello","sequence":"first","affiliation":[{"name":"S.C. Cardiology, Institute National Cancer, IRCCS, Foundation \u201cG. Pascale\u201d, Via M. 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