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

Citation
Ey. Chakhtoura et al., In-stent restenosis after carotid angioplasty-stenting: Incidence and management, J VASC SURG, 33(2), 2001, pp. 220-225
Citations number
30
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF VASCULAR SURGERY
ISSN journal
0741-5214 → ACNP
Volume
33
Issue
2
Year of publication
2001
Pages
220 - 225
Database
ISI
SICI code
0741-5214(200102)33:2<220:IRACAI>2.0.ZU;2-U
Abstract
Purpose: Carotid angioplasty-stenting (CAS) has been advocated as an altern ative to carotid endarterectomy (CEA) in patients with restenotic lesions a fter prior CEA, primary stenoses with significant medical comorbidities, an d 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 GAS. Methods: Patients with asymptomatic (61%) and symptomatic (39%) carotid ste nosis of greater than or equal to 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 ultrasonog raphy (DU) at 3- to 6-month intervals. In-stent restenoses greater than or equal to 80% detected with DU were further evaluated by means of angiograph y for confirmation of the severity of stenosis. Results: No periprocedural or late strokes occurred in the 50 CAS procedure s during the 30-day follow-up period. One death (2.2%) that resulted from m yocardial infarction was observed 10 days after discharge following GAS. Du ring a mean follow-up period of 18 +/- 10 months (range, 1-44 months), in-s tent restenosis was observed after four (8%) of the 50 CAS procedures. Angi ography confirmed these high-grade (greater than or equal to 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 o ver 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 stenos es. In-stent restenoses occurred after 8% of CAS procedures and were manage d without complications with repeat angioplasty or repeat angioplasty and r estenting.