title: In-stent restenosis after carotid angioplasty-stenting: incidence and management.
abstract: OBJECTIVE
  Carotid angioplasty-stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in patients with restenotic lesions after prior CEA, primary stenoses with significant medical comorbidities, and radiation-induced stenoses. The incidence of restenosis after CAS and its management remains ill defined. We evaluated the incidence and management of in-stent restenosis after CAS.
  
  
  METHODS
  Patients with asymptomatic (61%) and symptomatic (39%) carotid stenosis of > or = 80% underwent CAS between September 1996 and May 2000; there were 50 procedures and 46 patients (26 men and 20 women). All patients were followed up clinically and underwent duplex ultrasonography (DU) at 3- to 6-month intervals. In-stent restenoses > or = 80% detected with DU were further evaluated by means of angiography for confirmation of the severity of stenosis.
  
  
  RESULTS
  No periprocedural or late strokes occurred in the 50 CAS procedures during the 30-day follow-up period. One death (2.2%) that resulted from myocardial infarction was observed 10 days after discharge following CAS. During a mean follow-up period of 18 +/- 10 months (range, 1-44 months), in-stent restenosis was observed after four (8%) of the 50 CAS procedures. Angiography confirmed these high-grade (> or = 80%) in-stent restenoses, which were successfully treated with balloon angioplasty (3) or angioplasty and restenting (1). No periprocedural complications occurred, and these patients remained asymptomatic and without recurrent restenosis over a mean follow-up time of 10 +/- 6 months.
  
  
  CONCLUSIONS
  We recommend CAS for post-CEA restenosis, primary stenoses in patients with high-risk medical comorbidities, and radiation-induced stenoses. In-stent restenoses occurred after 8% of CAS procedures and were managed without complications with repeat angioplasty or repeat angioplasty and restenting.
authors.affiliation: Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 07103, USA.
authors.forename: E Y
authors.initials: EY
authors.lastname: Chakhtoura
authors.forename: R W
authors.initials: RW
authors.lastname: Hobson
authors.forename: J
authors.initials: J
authors.lastname: Goldstein
authors.forename: G T
authors.initials: GT
authors.lastname: Simonian
authors.forename: B K
authors.initials: BK
authors.lastname: Lal
authors.forename: P B
authors.initials: PB
authors.lastname: Haser
authors.forename: M B
authors.initials: MB
authors.lastname: Silva
authors.forename: F T
authors.initials: FT
authors.lastname: Padberg
authors.forename: P J
authors.initials: PJ
authors.lastname: Pappas
authors.forename: Z
authors.initials: Z
authors.lastname: Jamil
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D018616:Ultrasonography, Doppler, Duplex