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Carotid Bypass Using Gore Hybrid Vascular Graft for In-stent Restenosis after Carotid Stenting
Andrea Agostinucci1, Andrea Cumino1, Roberta Suita1
1Division of Vascular and Endovascular Surgery, San Giovanni Bosco Hospital, Turin, Italy.
Insights
In-stent restenosis after carotid artery stenting is common. A carotid bypass graft successfully treated severe recurrent restenosis in a complex case.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Case Reports
Background:
- In-stent restenosis (ISR) is a frequent complication after carotid artery stenting (CAS), occurring in 3.5% to 21% of patients.
- Optimal management strategies for ISR post-CAS remain unclear, with various endovascular and surgical options proposed.
- Surgical intervention for ISR in patients with prior ipsilateral endarterectomy presents significant technical challenges.
Observation:
- This report details a case of severe, recurrent ISR following CAS for postendarterectomy restenosis.
- The patient presented with complex restenosis requiring intervention.
- The condition occurred in a previously operated carotid artery.
Findings:
- A straightforward and successful treatment was achieved using carotid bypass surgery.
- A Gore® Hybrid Vascular Graft was utilized for the bypass procedure.
- This approach effectively resolved the severe recurrent ISR.
Implications:
- Carotid bypass grafting can be a viable and effective treatment for complex ISR after CAS.
- This case highlights a successful management strategy for a challenging clinical scenario.
- Further research may explore the role of bypass grafting in managing ISR post-CAS, especially in high-risk patients.
Abstract:
In-stent restenosis (ISR) is the most common long-term complication following carotid artery stenting (CAS), affecting 3.5% to 21% of patients after a mean follow-up of 18 months in published reports. Until now, the optimal management for ISR after CAS is still not clear, and different endovascular treatments along with various surgical options have been proposed. Moreover, surgical treatment for ISR in a previously operated patient of ipsilateral endarterectomy is a technically demanding procedure. In this report, we describe a case of severe carotid recurrent ISR, which occurred after CAS for postendarterectomy restenosis, that was successfully treated, in a straightforward way, with a carotid bypass using a Gore® Hybrid Vascular Graft.
