Technical options for treatment of in-stent restenosis after carotid artery stenting

Abstract

The available evidence for ISR treatment is still limited owing to methodologic heterogeneity; therefore, no recommendation on the optimal intervention can be provided. Although PTA is the common treatment for ISR, recurrent ISR seems to limit the durability, leading to recurrent interventions and cost implications. A uniform definition for ISR is needed with a standardized workup to compare the treatment options based on individual patient data analysis. Drug-eluting techniques are emerging and may become the preferred treatment option, but long-term follow-up is needed to evaluate their efficacy. Further study and understanding of the effect of drug-eluting technologies on the brain and neurologic function is warranted.

Drug‐Eluting Balloon Angioplasty for In‐Stent Restenosis Following Carotid Artery Stent Placement

“…This could explain the varying results seen across different case series of carotid ISR treated with the DEB. In an updated review by Pourier et al, 10 a total of 239 interventions were reported in 234 patients with carotid ISR. Recurrent carotid stenosis was observed in 47 patients.…”

“…A written consent was obtained from both patients prior to the procedure. We used DEB for angioplasty as “off‐label use of FDA approved device” similar to cutting and scoring balloons for carotid ISR in previous studies 10 . Off‐label use is relatively common as companies do not seek U.S Food and Drug Administration (FDA) approval for neurovascular application for rare indications such as carotid artery ISR due to small market 26 .…”

“…Although there is a risk of progression to symptomatic carotid occlusion or stroke, severe ISR (defined as >70% stenosis on Duplex ultrasound) 8 should be considered for treatment 9 . Several treatment approaches for management of ISR have been introduced including balloon angioplasty using a conventional, cutting, or scoring balloon or new stent placement with either a bare metal or drug‐eluting stent 10 . As per the 2014 European guidelines, use of another drug‐eluting stent has been recommended for treatment of in‐stent coronary artery restenosis (class I, level of evidence A), with evidence of improved angiographic and clinical results compared to other methods 11 .…”

Surgical treatment of a patient with stent restenosis in the mouth of the general carotid artery and the proximal department of the internal carotid artery

“…До 2013 г. в мировой практике зарегистрировано лишь 39 пациентов, которым проведена КЭЭ с удалением стента из внутренней сонной артерии, и 200 больных, которым выполнено повторное эндоваскулярное лечение [5,6]. Частота инсульта По данным исследований, среднее время рецидивирующих симптомов после КАС составляет 6,5 мес.…”

“…(диапазон от 2 до 54 мес.) [4][5][6]. Чаще всего это пациенты пожилого возраста (средний возраст 67 лет), мужского пола, с выраженной коморбидной патологией [4][5][6].…”