title: Long-term results of drug-eluting balloon angioplasty for treatment of refractory recurrent carotid in-stent restenosis.
abstract: OBJECTIVE
  To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR).
  
  
  METHODS
  Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenosis). Of these, 9 patients (7 women; mean age 78.1±5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4±0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter.
  
  
  RESULTS
  Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87%±4% to 6%±4% post treatment. Peak systolic velocity decreased significantly from 4.7±1.5 m/s to 0.6.±0.3 m/s after the procedure. Over a mean follow-up of 36.6±2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months.
  
  
  CONCLUSIONS
  DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.
authors.affiliation: 1 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, and Radiation Therapy, and the.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.forename: Valerio
authors.initials: V
authors.lastname: Da Ros
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sallustio
authors.forename: Simone
authors.initials: S
authors.lastname: Altobelli
authors.forename: Adolfo
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Sergio
authors.initials: S
authors.lastname: Abrignani
authors.forename: Erald
authors.initials: E
authors.lastname: Vasili
authors.forename: Paolo
authors.initials: P
authors.lastname: Stanzione
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001783:Blood Flow Velocity; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D058426:Neointima; D017239:Paclitaxel / Q000008:administration & dosage*; D011474:Prosthesis Design; D012008:Recurrence; D012039:Regional Blood Flow; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014654:Vascular Patency
chemical_list: D002317:Cardiovascular Agents; D017239:Paclitaxel
keywords: carotid artery stenting; drug-coated balloon; drug-eluting balloon; in-stent restenosis; paclitaxel; recurrent restenosis