title: Drug-eluting balloon for treatment of in-stent restenosis after carotid artery stenting: preliminary report.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of drug-eluting balloons (DEB) for the treatment of in-stent restenosis (ISR) after carotid artery stenting (CAS).
  
  
  METHODS
  Among 830 consecutive patients undergoing CAS between November 2001 and June 2012, significant ISR (>80% stenosis) occurred in 10 (1.2%) asymptomatic patients. Angioplasty with DEB treatment was performed in 7 patients (6 internal and 1 common carotid arteries) at a mean of 20.9 ± 19.4 months (median 12.1) after CAS. Intravascular ultrasound (IVUS)-guided predilation with distal cerebral protection was carried out with a cutting balloon followed by inflation of a DEB with a 1:1 stent-to-balloon size ratio.
  
  
  RESULTS
  Technical/procedural success was achieved in all cases. Angiographic stenosis decreased from 83%± 5% to 18%± 6%. At IVUS evaluation, minimal lumen area increased from 3.19 ± 1.73 to 12.78 ± 1.97 mm(2) (p=0.0001), stent area was unchanged (from 17.36 ± 4.36 to 17.52 ± 4.34 mm(2), p=0.70), and the restenosis area decreased from 13.58 ± 5.27 to 4.71 ± 3.06 mm(2) (p=0.0005). At a mean follow-up of 13.7 ± 1.5 months (median 13.7), 1 patient had a minor stroke ipsilateral to the ISR vessel 2 months after DEB treatment; the stent was widely patent on duplex ultrasound and angiographic images. Overall, the average PSV decreased from 4.0 ± 1.0 to 0.9 ± 0.1 m/s (p=0.0001). At 6 and 12 months, PSVs after DEB treatment were significantly lower compared to those assessed at comparable intervals after CAS.
  
  
  CONCLUSIONS
  The use of DEBs to treat ISR after CAS shows promising acute and midterm results.
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy. piero.montorsi@unimi.it
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Stefano
authors.initials: S
authors.lastname: Galli
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Ravagnani
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lualdi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Teruzzi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Riva
authors.forename: Sarah
authors.initials: S
authors.lastname: Troiano
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D057785:Catheters; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D014654:Vascular Patency
chemical_list: D002317:Cardiovascular Agents; D020099:Coated Materials, Biocompatible; D017239:Paclitaxel