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Single-center experience with carotid stent restenosis
Andrea Willfort-Ehringer1, Ramazanali Ahmadi, Michael E Gschwandtner
1Department of Medical Angiology, General Hospital of Vienna, University of Vienna Medical School, Währinger Gürtel 18-20, A-1090 Vienna, Austria. andrea.wilfort@akh-wien.ac.at
Insights
Carotid stent restenosis is rare, typically occurring within a year. Percutaneous interventions offer safe treatment options for these recurrent internal carotid artery stenoses.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenosis poses a significant risk for stroke.
- Stent placement is a common treatment for internal carotid artery stenosis.
- Restenosis after stenting can lead to recurrent symptoms and complications.
Purpose of the Study:
- To describe the angiographic features of carotid stent restenosis.
- To evaluate therapeutic outcomes for carotid stent restenosis.
- To report single-center experience with carotid stent restenosis management.
Main Methods:
- Retrospective analysis of 303 successful Wallstent placements in internal carotid arteries.
- Follow-up with duplex sonography and angiography for recurrent lesions (> or =70%).
- Treatment involved balloon dilation with or without additional stent placement.
Main Results:
- Nine cases (3.0%) of carotid stent restenosis occurred within 12 months.
- Two types identified: 'in-stent' (n=6) and 'end of stent' (n=3).
- Successful retreatment achieved with further stenting or balloon dilation; no early complications.
Conclusions:
- Carotid stent restenosis is an uncommon complication, rarely seen after one year.
- Further percutaneous interventions provide safe and effective treatment for carotid stent restenosis.
- Differentiation of restenosis types guides successful therapeutic strategies.
Purpose:
To report the angiographic morphology of carotid stent restenosis and the possible therapies based on data from a single-center experience.
Methods:
In a 45-month period, 279 patients (196 men; mean age 70 +/- 9 years, range 50-89) underwent successful Wallstent placement in 303 stenotic internal carotid arteries (ICA). Patients were followed with duplex sonography; angiography was used to confirm any significant (> or =70%) recurrent lesions detected on the ultrasound scan. Further balloon dilation with or without stent placement was undertaken. RESULTS; Over a median 12-month follow-up (interquartile range 6-24), there were 9 (3.0%) carotid stent restenoses found, all within 12 months after stent placement. Two types of restenosis were differentiated. In the more common form, "in-stent" stenoses (n = 6) were detected and treated with stent placement; lasting success (patency >12 months after retreatment) was achieved in 4. Early second and third recurrences arose in the other 2 stents within 3 months of the first retreatment; additional stents were placed at each recurrence. Both patients suffered a major cerebral event after 17 months. Less often, an "end of stent" stenosis (n = 3) developed at a kink in the ICA adjacent to the cephalad end of the stent. Lasting success was achieved by balloon dilation without additional stent placement in all 3 cases. No procedure-related complications were observed within 30 days after any treatment for restenosis.
Conclusions:
Carotid stent restenosis, which occurs rarely after 1 year, can be treated safely by further percutaneous interventions.