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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2008 September;15(3):171-8
In-stent restenosis after carotid angioplasty and stenting
Setacci C., de Donato G., Chisci E., Setacci F., Sirignano P., Galzerano G., Cappelli A., Palasciano G.
Department of Vascular and Endovascular Surgery University of Siena, Siena, Italy
Carotid artery stenting (CAS) is a viable alternative to carotid endarterectomy (CEA) in selected patients with a severe carotid stenosis. Long-term patency following CAS can be limited by restenosis due to neointimal hyperplasia or recurrent atherosclerosis. CAS patients require intensive follow-up to monitor the patency of the device and the potential development of an in-stent restenosis (ISR), which continues to be the “Achilles’ heel” of any catheter intervention.ISR after CAS is now considered to have a lower incidence in comparison to other vascular distrticts. The literature reported a progressive reduction of the incidence of carotid ISR by the years, from 15% to the actual 1-3%/year. Long-term results in several published cohort of patients in literature seems to validate CAS as a durable procedure for stroke prevention. The ISR rate appears to be acceptable, and the need for reintervention is low. There are several putative causes of re-stenosis after CAS, but the literature is not conclusive about true predictors of ISR.A rigorous duplex ultrasound follow-up of CAS with corrected velocity criteria is mandatory to early recognize any kind of late complications. In-stent restenotic carotid lesions may be safely treated by further percutaneous interventions.