Stent-in-Stent Endovascular Correction in Right Internal Carotid Artery Restenosis: a Clinical Case

Abstract

Background. Carotid artery restenosis is a rare complication of carotid stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reveals an in-stent restenosis rate of 0–6 %, a fairly low value given an extensive study sampling of patients. Restenosis still lacks an adequate explanation in endovascular carotid surgery. Intravascular ultrasound visualisation, drug-coated balloons, stent reimplantation or reconstructive surgery have actively been used since relatively recently to tackle restenosis. Drug-coated balloons may fail in certain cases due to hampered restenosis angioplasty in a markedly rigid neointimal hyperplasia. Surgical reconstruction also possessed drawbacks, mostly due to obstacles in the stent removal and the procedure infeasibility in high-risk surgical patients.Materials and methods. The article describes a clinical case of stent-in-stent restenosis correction with drug-coated balloon-expandable re-stenting of right internal carotid artery and a long-term prognosis estimation with optical coherence tomography.Results and discussions. This tactic was adopted due to haemodynamically and clinically significant internal carotid artery restenosis, the patient’s denial of carotid endarterectomy and insufficiently effective balloon angioplasty. The choice of the correction technique was conclusive basing on a negative stent deformation testing that showed the lack of deforming stress factors at internal carotid artery restenosis. Intravascular imaging greatly enhances our ability to understand and assess endovascular processes.Conclusion. We consider clinically significant restenoses in previously stented carotid arteries as requiring further research effort, with the clinical case presented describing an individual solution.