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A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
Published on: July 9, 2020
Drug-eluting balloon angioplasty for carotid in-stent restenosis
Francesco Liistro1, Italo Porto, Simone Grotti
1Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, Italy.
Insights
Drug-eluting balloons (DEBs) show promising midterm results for managing carotid artery in-stent restenosis (ISR). This approach maintained stent patency and kept patients asymptomatic in a small case series.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Neurology
Background:
- Carotid in-stent restenosis (ISR) poses a challenge after carotid artery stenting.
- Current management options for carotid ISR have limitations.
Observation:
- Three patients with asymptomatic severe carotid ISR (>80% stenosis) were treated with paclitaxel-eluting drug-eluting balloons (DEBs).
- The procedure involved predilation and dual inflations of the DEB under filter protection.
- Patients received 3 months of dual antiplatelet therapy post-procedure.
Findings:
- Midterm follow-up (12, 22, 36 months) showed patients remained asymptomatic.
- Duplex ultrasound confirmed sustained stent patency at 6, 12, and 24 months post-treatment.
- Successful management of severe carotid ISR was achieved using DEBs.
Implications:
- Drug-eluting balloons represent an emerging and effective strategy for carotid ISR.
- These preliminary findings suggest DEBs offer encouraging midterm outcomes.
- Larger studies are warranted to validate these results in broader patient populations.
Purpose:
To report midterm results of 3 cases in which drug-eluting balloons (DEBs) were successfully used for the management of carotid in-stent restenosis (ISR).
Case Report:
Two women aged 68 and 70 years and a 68-year-old man were referred to our institution for asymptomatic severe stenosis [>80% with peak systolic velocity (PSV) >300 cm/s by Doppler ultrasound assessment] of individual Carotid Wallstents implanted in the proximal left internal carotid artery (ICA). In the angiosuite, the left ICA was engaged in a telescopic fashion with a triple coaxial system formed by a 6-F long sheath and a preloaded 5-F, 125-cm diagnostic catheter over a 0.035-inch soft hydrophilic guidewire. Under distal filter protection, the lesions were predilated using a 3.5 × 20-mm coronary balloon and then treated with two 1-minute inflations of a 4 × 40-mm Amphirion In.Pact paclitaxel-eluting balloon, followed by 3 months of dual antiplatelet therapy. At 12, 22, and 36 months, respectively, the patients are still asymptomatic, with duplex-documented stent patency at 6, 12, and 24 months, respectively.
Conclusion:
DEBs are an emerging strategy for carotid ISR, with encouraging midterm results in these patients. Further experience in larger cohorts is needed to confirm these preliminary observations.
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