Endovascular treatment of in-stent restenosis after carotid artery stenting: immediate and midterm results

Purpose: To evaluate the immediate and midterm outcome and analyze the debris captured after repeat enclovascular intervention for the treatment of in-stent restenosis after carotid artery stenting (CAS). Methods: Thirty-one consecutive patients (27 men; mean age 63.7 +/- 13.0 years, range 53-81) underwent repeat endovascular intervention (balloon angioplasty and provisional stenting) for the treatment of 32 in-stent restenoses following CAS. Results: Procedural success was achieved in all patients. An additional stent was implanted in 10 (31%) cases. No procedural complication was observed. Filter analysis was performed in 17 (53%) procedures; on 12 (71%), macroscopically visible material was captured. The histomorphometric analysis performed on 6 (19%) filters showed fibrin nets entrapping erythrocytes, leucocytes, platelets, and in 2 cases, fibrous hypercellular tissue fragments. At 30 days and during follow-up (mean 17 +/- 5 months), no deaths, transient ischernic attacks, or strokes were observed. In 1 (3.1%) patient, asymptomatic recurrence of ISR was found on Doppler ultrasonography and successfully treated with balloon angioplasty. Conclusion: Repeat endovascular intervention using balloon angioplasty with provisional stenting and routine cerebral protection appears to be a feasible, safe, and clinically effective strategy for the treatment of in-stent restenosis after CAS.