Endovascular treatment of in-stent restenosis after carotid artery stenting: immediate and midterm results.
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.
Reimers
Bernhard
B
Cardiology Department, Mirano Hospital, Italy. emodinamica@ulss13mirano.ven.it
Tübler
Thilo
T
de Donato
Giammarco
G
Della Barbera
Mila
M
Cernetti
Carlo
C
Schlüter
Michael
M
Mistrorigo
Flavio
F
Saccà
Salvatore
S
Favero
Luca
L
Setacci
Francesco
F
Setacci
Carlo
C
Thiene
Gaetano
G
Schofer
Joachim
J
Angelini
Annalisa
A
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