In-stent restenosis after carotid angioplasty-stenting: Incidence and management

Elie Y. Chakhtoura, Robert W. Hobson, Jonathan Goldstein, Gregory T. Simonian, Brajesh K. Lal, Paul B. Haser, Michael B. Silva, Frank T. Padberg, Peter J. Pappas, Zafar Jamil

Research output: Contribution to journalArticle

144 Scopus citations

Abstract

Purpose: Carotid angioplasty-stenting (CAS) has been advocated as an alternative to carotid endarterectomy (CEA) in patients with restenotic lesions after prior CEA, primary stenoses with significant medical comorbidities, and radiation-induced stenoses. The incidence of restenosis after CAS and its management remains ill defined. We evaluated the incidence and management of in-stent restenosis after CAS. Methods: Patients with asymptomatic (61%) and symptomatic (39%) carotid stenosis of ≥ 80% underwent CAS between September 1996 and May 2000; there were 50 procedures and 46 patients (26 men and 20 women). All patients were followed up clinically and underwent duplex ultrasonography (DU) at 3- to 6-month intervals. In-stent restenoses ≥ 80% detected with DU were further evaluated by means of angiography for confirmation of the severity of stenosis. Results: No periprocedural or late strokes occurred in the 50 CAS procedures during the 30-day follow-up period. One death (2.2%) that resulted from myocardial infarction was observed 10 days after discharge following CAS. During a mean follow-up period of 18 ± 10 months (range, 1-44 months), in-stent restenosis was observed after four (8%) of the 50 CAS procedures. Angiography confirmed these high-grade (≥ 80%) in-stent restenoses, which were successfully treated with balloon angioplasty (3) or angioplasty and restenting (1). No periprocedural complications occurred, and these patients remained asymptomatic and without recurrent restenosis over a mean follow-up time of 10 ± 6 months. Conclusions: We recommend CAS for post-CEA restenosis, primary stenoses in patients with high-risk medical comorbidities, and radiation-induced stenoses. In-stent restenoses occurred after 8% of CAS procedures and were managed without complications with repeat angioplasty or repeat angioplasty and restenting.

Original languageEnglish (US)
Pages (from-to)220-226
Number of pages7
JournalJournal of vascular surgery
Volume33
Issue number2
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Chakhtoura, E. Y., Hobson, R. W., Goldstein, J., Simonian, G. T., Lal, B. K., Haser, P. B., Silva, M. B., Padberg, F. T., Pappas, P. J., & Jamil, Z. (2001). In-stent restenosis after carotid angioplasty-stenting: Incidence and management. Journal of vascular surgery, 33(2), 220-226. https://doi.org/10.1067/mva.2001.111880