Operative management of carotid artery in-stent restenosis: first experiences and duplex follow-up

Eur J Vasc Endovasc Surg. 2003 Aug;26(2):137-40. doi: 10.1053/ejvs.2002.1916.


Objectives: Carotid Artery Stenting (CAS) may be comparable to Carotid Endarterectomy (CEA) as a durable and effective procedure in stroke prevention. Concern remains about the incidence of restenosis after stenting and its management. We evaluated the surgical management of restenosis after CAS.

Design: prospective study.

Methods: between December 1997 and April 2001, 217 CAS procedures were performed in 217 patients (155 men and 62 women; age 70 years +/- 8.2). After a mean of 8 months post-stenting four patients (two symptomatic, two asymptomatic with contralateral occlusion) with severe haemodynamic in-stent restenosis (90-99%) had surgical reintervention.

Results: standard CEA with removal of the stent was performed in all four patients. No major complications occurred. Intima hyperplasia showed to be the predominant mechanism leading to in-stent restenosis. All four surgically treated patients remained asymptomatic and without recurrent restenosis over a mean follow-up time of 13 months (range 3-20 months).

Conclusion: the optimal treatment of in-stent restenosis has yet to be defined, but standard CEA with removement of the stent appears to be feasible.

MeSH terms

  • Aged
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / surgery*
  • Carotid Stenosis / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Prospective Studies
  • Recurrence
  • Stents*
  • Ultrasonography, Doppler, Duplex