Operative management of carotid artery in-stent restenosis: first experiences and duplex follow-up.
OBJECTIVE
Carotid Artery Stenting (CAS) may be comparable to Carotid Endarterectomy (CEA) as a durable and effective procedure in stroke prevention. Concern remains about the incidence of restenosis after stenting and its management. We evaluated the surgical management of restenosis after CAS.


METHODS
prospective study.


METHODS
between December 1997 and April 2001, 217 CAS procedures were performed in 217 patients (155 men and 62 women; age 70 years +/- 8.2). After a mean of 8 months post-stenting four patients (two symptomatic, two asymptomatic with contralateral occlusion) with severe haemodynamic in-stent restenosis (90-99%) had surgical reintervention.


RESULTS
standard CEA with removal of the stent was performed in all four patients. No major complications occurred. Intima hyperplasia showed to be the predominant mechanism leading to in-stent restenosis. All four surgically treated patients remained asymptomatic and without recurrent restenosis over a mean follow-up time of 13 months (range 3-20 months).


CONCLUSIONS
the optimal treatment of in-stent restenosis has yet to be defined, but standard CEA with removement of the stent appears to be feasible.
de Borst
G J
GJ
Department of Vascular Surgery, St Antonius Hospital Nieuwegein, 3430 EM Nieuwegein, The Netherlands.
Ackerstaff
R G A
RG
Mauser
H W
HW
Moll
F L
FL
D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex