eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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4/2019
vol. 15
 
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abstract:
Original paper

Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS)

Łukasz Tekieli
1
,
Piotr Musiałek
2
,
Anna Kabłak-Ziembicka
1
,
Mariusz Trystuła
3
,
Tadeusz Przewłocki
1
,
Jacek Legutko
1
,
Karolina Dzierwa
1
,
Damian Maciejewski
1
,
Michał Michalski
4
,
Piotr Pieniążek
1

  1. Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
  2. Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
  3. Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
  4. Department of Neurology with Stroke Division, John Paul II Hospital, Krakow, Poland
Adv Interv Cardiol 2019; 15, 4 (58): 465–471
DOI: https://doi.org/10.5114/aic.2019.90221
Online publish date: 2019/12/08
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Introduction
Optimal management of severe carotid in-stent restenosis remains unknown. Prevalence and risk factors of first and recurrent carotid in-stent restenosis in the multi-stent approach have not been established yet.

Aim
To evaluate the safety of different methods of endovascular treatment of carotid in-stent restenosis/recurrent restenosis and to establish its rate and risk factors.

Material and methods
Between January 2001 and June 2016, 2637 neuroprotected carotid artery stenting (CAS) procedures were performed in 2443 patients (men: 67.0%; mean age: 67.9 ±8.8 years, symptomatic: 45.5%). Doppler ultrasound (DUS) evaluation was performed at discharge, after 3–6 months, 12 months, and then annually. Peak systolic velocity of 2–3 and > 3.0 m/s as well as end diastolic velocity of 0.5–0.9 and > 0.9 m/s were DUS criteria for 50–69% and ≥ 70% carotid in-stent restenosis (ISR) respectively. For angiographically confirmed ≥ 70% stenosis balloon re-angioplasty was first line treatment.

Results
Out of 95 DUS detected > 50% ISR (95/2637; 3.6%), 53 were confirmed in angiography as ≥ 70% (53/2637; 2.0%, one total occlusion). All patients were treated with bare balloon (n = 19), drug-eluting balloon (n = 27) or stent-supported (n = 6) angioplasty. One procedure was complicated with stroke (1.9%). Angiographic diameter stenosis (DS) was reduced from 83 ±8.3% to 13 ±7.6% (p < 0.001). There were 13 cases of ≥ 70% recurrent ISR. Bilateral and high-grade stenosis were independent risk factors of restenosis. Initial Carotid Wallstent implantation was a risk factor of first and recurrent in-stent restenosis.

Conclusions
Endovascular treatment of carotid in-stent restenosis is safe. Bilateral and high-grade carotid artery stenosis may increase the risk of restenosis. Initial Carotid Wallstent implantation may increase the risk of first and recurrent restenosis.

keywords:

risk factors, carotid artery, carotid artery stenting, in-stent restenosis, Carotid Wallstent
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