In-stent restenosis after carotid angioplasty-stenting: Incidence and management

• Published in: Journal of vascular surgery Vol. 33; no. 2; pp. 220 - 226
• Main Authors: Chakhtoura, Elie Y., Hobson, Robert W., Goldstein, Jonathan, Simonian, Gregory T., Lal, Brajesh K., Haser, Paul B., Silva, Michael B., Padberg, Frank T., Pappas, Peter J., Jamil, Zafar
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-02-2001
• Subjects: Aged; Angioplasty, Balloon - adverse effects; Carotid Arteries - diagnostic imaging; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - therapy; Endarterectomy, Carotid; Female; Follow-Up Studies; Humans; Male; Radiography; Recurrence; Stents - adverse effects; Ultrasonography, Doppler, Duplex
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.111880

Purpose: Carotid angioplasty-stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in patients with restenotic lesions after prior CEA, primary stenoses with significant medical comorbidities, and radiation-induced stenoses. The incidence of restenosis after CAS and its management remains ill defined. We evaluated the incidence and management of in-stent restenosis after CAS. Methods: Patients with asymptomatic (61%) and symptomatic (39%) carotid stenosis of ≥ 80% underwent CAS between September 1996 and May 2000; there were 50 procedures and 46 patients (26 men and 20 women). All patients were followed up clinically and underwent duplex ultrasonography (DU) at 3- to 6-month intervals. In-stent restenoses ≥ 80% detected with DU were further evaluated by means of angiography for confirmation of the severity of stenosis. Results: No periprocedural or late strokes occurred in the 50 CAS procedures during the 30-day follow-up period. One death (2.2%) that resulted from myocardial infarction was observed 10 days after discharge following CAS. During a mean follow-up period of 18 ± 10 months (range, 1-44 months), in-stent restenosis was observed after four (8%) of the 50 CAS procedures. Angiography confirmed these high-grade (≥ 80%) in-stent restenoses, which were successfully treated with balloon angioplasty (3) or angioplasty and restenting (1). No periprocedural complications occurred, and these patients remained asymptomatic and without recurrent restenosis over a mean follow-up time of 10 ± 6 months. Conclusions: We recommend CAS for post-CEA restenosis, primary stenoses in patients with high-risk medical comorbidities, and radiation-induced stenoses. In-stent restenoses occurred after 8% of CAS procedures and were managed without complications with repeat angioplasty or repeat angioplasty and restenting. (J Vasc Surg 2001;33:220-6.)