Radiation to the head and neck region has recently been established as a significant risk factor for the development of extracranial carotid stenosis. The underlying pathophysiology is similar to non-radiation induced atherosclerosis. However, the extent of involvement, the rapid progression as compared with patients without irradiation suggests that this is a unique disease entity, which warrants close surveillance, especially for patient with relatively good prognosis. Surgical intervention could be difficult in this group of patients who suffered from fibrosis related to radiation. Carotid stenting has recently served as a safe and effective alternative treatment for the disease.