Ten years after irradiation of the neck for a tonsillar carcinoma, a 59-year-old woman is found to have symptomatic carotid artery disease. Arteriogram shows a 70% irregular stenotic lesion. The following is/are true:

c. If atherosclerotic disease is found, the plaque will be no different than nonirradiated plaques

Radiation-induced arterial injury produces three types of injury, the earliest post-treatment consisting of inflammatory reaction with endothelial slough and thrombosis. Later, there may be fibrotic changes in the wall producing stenosis or accelerated atherosclerosis. The latter lends itself to standard endarterectomy and the plaque is indistinguishable from nonirradiated plaque.