Abstract: Carotid artery stenosis (CAS) is a significant cause of stroke, with common risk factors including advanced age, diabetes, coronary artery disease, smoking, and a history of stroke or transient ischemic attack (TIA). An often underrecognized cause is radiation-induced CAS, which can lead to serious complications. While radiotherapy plays a vital role in managing head and neck cancers, it may also damage blood vessels, leading to vascular disease.We report the case of a 71-year-old male with bilateral carotid stenosis secondary to prior radiotherapy, who presented with an acute left cortical infarct. Case Details: The patient arrived with sudden onset of left facial deviation and right-sided weakness, scoring an NIHSS of 8. He had a medical history of hypertension and tongue cancer, treated with chemotherapy and radiotherapy in 2019. MRI revealed an acute infarct in the left cerebral cortex. Cerebral digital subtraction angiography (DSA) showed 70% stenosis of the right internal carotid artery (ICA) and 90% stenosis of the left ICA. As he was outside the window for thrombolysis, conservative management was initiated, followed by left ICA stenting. Post-procedure, he showed good recovery and was discharged on dual antiplatelet therapy and statins. Discussion: Radiation-induced CAS occurs in approximately 25% of patients, with a cumulative 10-year risk exceeding 25%. The incidence varies depending on cancer type, and data specific to tongue carcinoma is limited. A study by Seto K et al., reported only a 4% incidence in tongue cancer patients, underscoring the need for more research. The scarcity of data hampers early diagnosis and preventive care for radiation-associated CAS. Conclusion: Managing radiation-induced CAS is complex due to fibrosis and scarring in the neck region. This case highlights the importance of routine follow-up in patients with a history of head and neck radiotherapy. Carotid Doppler ultrasound may serve as an effective screening tool for early detection.