Neck radiotherapy is an important means to prevent and treat cervical lymph node metastasis of nasopharyngeal carcinoma. Studies have found that radiation can directly or indirectly damage blood vessels, accelerate the process of atherosclerosis, and then cause carotid artery stenosis, increasing the risk of transient cerebral ischemia and stroke after radiotherapy. At present, we often apply color doppler ultrasound to detect the changes of carotid artery and actively prevent and reduce risk factors to decrease the occurrence of carotid artery stenosis. Carotid artery stenosis can be treated with early drug intervention and surgery. This article reviews the current research status of carotid artery injury caused by radiotherapy.