In-stent Restenosis After Carotid Angioplasty and Stenting: A Challenge for the Vascular Surgeon

Abstract

Our experience with a large cohort of CAS showed an encouragingly low incidence of ISR (3.6%) and successful treatment by repeat endovascular intervention. We recommend attempting all endovascular possibilities before performing stent removal.

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…368 Device malfunction that results in deployment failure, stent malformation, and migration after deployment is rare, occurring in Ͻ1% of procedures. 540,541,[572][573][574][575][576] If properly deployed, EPDs can reduce the neurological risks associated with CAS, but these devices may also be associated with failures, 372,521,523,572,577-583 including inability to deliver the device to the target zone because of a large profile and reduced steerability and ischemia if the device becomes overloaded with embolic material during deployment. Sizing of the EPD is important, because undersizing allows passage of debris into the distal circulation and oversizing can cause endothelial damage or provoke vasospasm.…”

Recurrent Subacute In-stent Restenosis After Carotid Artery Stenting due to Plaque Protrusion -Case Report-

“…3,9,25,26,30) CEA was successful 6 months after CAS with a stainless steel stent. 30) Three patients were managed surgically for acute restenosis after CAS, but the operation was complicated by the length of ICA exposure required, difficulty in opening the stented artery, and the care necessary in removing the plaque and stent to avoid vessel wall penetration.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

“…49 Device malfunction that results in deployment failure, stent malformation, and migration after deployment is rare, occurring in <1% of procedures. [245][246][247][248][249][250][251] If properly deployed, an EPD can reduce the neurological risks associated with CAS, but these devices may also be associated with failures. 53,196,198,247,[252][253][254][255][256][257][258] Among the general risks is access-site injury, which complicates 5% of cases, but most such injuries involve pain and hematoma formation and are self-limited.…”