Single-center experience with carotid stent restenosis

Abstract

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.