In-stent restenosis after carotid angioplasty and stenting

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 hi 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.