title: The myth of restenosis after carotid angioplasty and stenting.
abstract: OBJECTIVE
  Reported rates of in-stent restenosis after carotid artery stenting (CAS) vary, and restenosis risk factors are poorly understood. We evaluated restenosis rates and risk factors, and compared patients with 'hostile-neck' carotids (a history of ipsilateral neck surgery or irradiation) and atherosclerotic lesions.
  
  
  METHODS
  Demographic, clinical, and radiological characteristics of patients undergoing cervical CAS between 1995 and 2010 with at least 1 month of follow-up were reviewed. Patients with substantial (≥50%) radiographic restenosis were compared with those without significant restenosis to identify restenosis risk factors.
  
  
  RESULTS
  The analysis included 121 patients with 133 stented vessels; 91 (68.4%) lesions were symptomatic. Indications for stent placement included hostile-neck lesions, substantial surgical comorbidities, inclusion in a randomized carotid stenting trial, acute carotid occlusion, tandem stenosis, large pseudoaneurysm, high carotid bifurcation, and contralateral laryngeal nerve palsy. Procedures were technically successful in all but one lesion (99.2%). Perioperative stroke occurred in four cases (3.0%). Mean follow-up was 38 months (range 1-204 months), during which 23 vessels (17.3%) developed restenosis. Hostile-neck carotids (n=57) comprised 42.9% of all vessels treated and were responsible for 15 of 23 restenosis cases, resulting in a significantly higher restenosis rate than that of primary atherosclerotic lesions (26.3% vs 10.5%, p=0.017). By univariate analysis, the presence of calcified plaque was significantly associated with the incidence of in-stent restenosis (p=0.02).
  
  
  CONCLUSIONS
  Restenosis rates after carotid angioplasty and stenting are low. Patients with a history of ipsilateral neck surgery or irradiation are at higher risk for substantial radiographic and symptomatic restenosis.
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Moon
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Azam S
authors.initials: AS
authors.lastname: Ahmed
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: M Yashar S
authors.initials: MY
authors.lastname: Kalani
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000453:epidemiology; D017130:Angioplasty; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D014826:Vocal Cord Paralysis / Q000150:complications / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Angiography; Angioplasty; Plaque; Stent; Stroke