Surgical Management of Acute Complications and Critical Restenosis following Carotid Artery Stenting

Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting

“…This periarterial inflammation and adhesion of the stent to the arterial wall was the reason that some surgeons chose to perform a transposition of the internal to the external carotid artery or to do bypass surgery instead of CEA to avoid a dissection in the inflamed area. 28,29 The interval between CAS and surgery might influence the severity of this vessel wall inflammatory reaction and therefore influence the choice of the type of surgical revascularization. Another major surgical challenge is to remove the distal part of the stent because this is usually placed in a nondiseased part of the ICA, potentially resulting in a locally very fragile arterial structure.…”

Carotid endarterectomy for treatment of in-stent restenosis

“…Three cases of acute surgical conversion for a thrombosed stent at the implant procedure or an acutely ruptured carotid artery have been reported with excellent neurological recovery. 14,18 Finally, eight patients with chronic ISR discovered 6 to 12 months postprocedure have been reported to have undergone successful CEA. The first case was reported in the neurosurgical literature from the University of Alabama.…”

“…One patient underwent external carotid to internal carotid transposition for proximal internal carotid ISR. 14 Two patients underwent polytetrafluoroethylene interposition grafts, 15 and four patients underwent reversed saphenous vein interposition grafts for ISR 14,16,17 without complication. Three cases of acute surgical conversion for a thrombosed stent at the implant procedure or an acutely ruptured carotid artery have been reported with excellent neurological recovery.…”

Management of a nontraumatic extracranial internal carotid aneurysm with external carotid transposition

“…Transposition has been effectively utilized in the treatment of vascular pathologies of various arterial positions, [8][9][10][11][12] including the internal carotid artery. [13][14][15][16] When anatomical concerns permit, the ECA is an attractive option because it eliminates the need for vein harvest or the use of synthetic materials. The need for prolonged antiplatelet or anticoagulant therapy is also mitigated with ECA use.…”