Bypass for symptomatic in-stent carotid restenosis

Stilo, Francesco; Sirignano, Pasqualino; Montelione, Nunzio; Mansour, Wassim; Capoccia, Laura; Catanese, Vincenzo; Spinelli, Francesco; Speziale, Francesco

doi:10.1016/j.ijcard.2017.09.166

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…A 100% patency rate was confirmed at a mean follow-up of 41.2±18.2 months. 43) As in several studies, balloon angioplasty was inferior to CAS in terms of recurrence rate. 11)28)30) ISR recurred in 2 out of 4 cases in balloon angioplasty cases.…”

Section: Discussionmentioning

confidence: 79%

Long-term outcomes of carotid artery stenting in patients with carotid artery stenosis: A single-center 14-year retrospective analysis

Kang

Yoon

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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Objective: Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution. Methods:We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke. Results:The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10. 2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002).Conclusions: CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion-related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.

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Section: Discussionmentioning

confidence: 79%

Long-term outcomes of carotid artery stenting in patients with carotid artery stenosis: A single-center 14-year retrospective analysis

Kang

Yoon

et al. 2023

J Cerebrovasc Endovasc Neurosurg

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“…However, a doublecenter study reported satisfactory results for patients treated by carotid bypass (CB) for symptomatic high-grade ISR after CAS. In this series performed on 13 patients, CB (either with great saphenous vein or polytetrafluoroethylene grafts), a 100% patency rate at a mean follow-up of 41.2±18.2 months with a minimal risk of transient cranial nerve damage (7.7%) was reported (84).…”

Section: Cea Vs Cas For Recurrent Carotid Stenosismentioning

confidence: 84%

“…According to a previously published experience with CB after CEA failure (139), the authors decided to submit patients to a more radical surgical solution by performing a complete exclusion of the diseased carotid wall after stent removal (84).…”

Section: Cea Vs Cas For Recurrent Carotid Stenosismentioning

confidence: 99%

The management of carotid restenosis: a comprehensive review

Stilo¹,

Montelione²,

Calandrelli³

et al. 2020

Ann Transl Med

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Carotid artery stenosis (CS) is a major medical problem affecting approximately 10% of the general population 80 years or older and causes stroke in approximately 10% of all ischemic events. In patients with symptomatic, moderate-to-severe CS, carotid endarterectomy (CEA) and carotid angioplasty and stenting (CAS), has been used to lower the risk of stroke. In primary CS, CEA was found to be superior to best medical therapy (BMT) according to 3 large randomized controlled trials (RCT). Following CEA and CAS, restenosis remains an unsolved problem involving a large number of patients as the current treatment recommendations are not as clear as those for primary stenosis. Several studies have evaluated the risk of restenosis, reporting an incidence ranging from 5% to 22% after CEA and an in-stent restenosis (ISR) rate ranging from 2.7% to 33%. Treatment and optimal management of this disease process, however, is a matter of ongoing debate, and, given the dearth of level 1evidence for the management of these conditions, the relevant guidelines lack clarity. Moreover, the incidence rates of stroke and complications in patients with carotid stenosis are derived from studies that did not use contemporary techniques and materials.Rapidly changing guidelines, updated techniques, and materials, and modern medical treatments make actual incidence rates barely comparable to previous ones. For these reasons, RCTs are critical for determining whether these patients should be treated with more aggressive treatments additional to BMT and identifying those patients indicated for surgical or endovascular treatments. This review summarizes the current evidence and controversies concerning the risks, causes, current treatment options, and prognoses in patients with restenosis after CEA or CAS.

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