title: Endovascular treatment of in-stent restenosis after carotid artery stenting: immediate and midterm results.
abstract: OBJECTIVE
  To evaluate the immediate and midterm outcome and analyze the debris captured after repeat endovascular intervention for the treatment of in-stent restenosis after carotid artery stenting (CAS).
  
  
  METHODS
  Thirty-one consecutive patients (27 men; mean age 63.7+/-13.0 years, range 53- 81) underwent repeat endovascular intervention (balloon angioplasty and provisional stenting) for the treatment of 32 in-stent restenoses following CAS.
  
  
  RESULTS
  Procedural success was achieved in all patients. An additional stent was implanted in 10 (31%) cases. No procedural complication was observed. Filter analysis was performed in 17 (53%) procedures; on 12 (71%), macroscopically visible material was captured. The histomorphometric analysis performed on 6 (19%) filters showed fibrin nets entrapping erythrocytes, leucocytes, platelets, and in 2 cases, fibrous hypercellular tissue fragments. At 30 days and during follow-up (mean 17+/-5 months), no deaths, transient ischemic attacks, or strokes were observed. In 1 (3.1%) patient, asymptomatic recurrence of ISR was found on Doppler ultrasonography and successfully treated with balloon angioplasty.
  
  
  CONCLUSIONS
  Repeat endovascular intervention using balloon angioplasty with provisional stenting and routine cerebral protection appears to be a feasible, safe, and clinically effective strategy for the treatment of in-stent restenosis after CAS.
authors.affiliation: Cardiology Department, Mirano Hospital, Italy. emodinamica@ulss13mirano.ven.it
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.forename: Thilo
authors.initials: T
authors.lastname: Tübler
authors.forename: Giammarco
authors.initials: G
authors.lastname: de Donato
authors.forename: Mila
authors.initials: M
authors.lastname: Della Barbera
authors.forename: Carlo
authors.initials: C
authors.lastname: Cernetti
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.forename: Flavio
authors.initials: F
authors.lastname: Mistrorigo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Saccà
authors.forename: Luca
authors.initials: L
authors.lastname: Favero
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
authors.forename: Annalisa
authors.initials: A
authors.lastname: Angelini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002339:Carotid Arteries / Q000473:pathology; D002341:Carotid Artery Thrombosis / Q000473:pathology / Q000628:therapy*; D016893:Carotid Stenosis / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D015607:Stents; D016896:Treatment Outcome