Long-term results of drug-eluting balloon angioplasty for treatment of refractory recurrent carotid in-stent restenosis

J Endovasc Ther. 2014 Oct;21(5):671-7. doi: 10.1583/14-4715MR.1.


Purpose: To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR).

Methods: Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenosis). Of these, 9 patients (7 women; mean age 78.1±5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4±0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter.

Results: Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87%±4% to 6%±4% post treatment. Peak systolic velocity decreased significantly from 4.7±1.5 m/s to 0.6.±0.3 m/s after the procedure. Over a mean follow-up of 36.6±2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months.

Conclusion: DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.

Keywords: carotid artery stenting; drug-coated balloon; drug-eluting balloon; in-stent restenosis; paclitaxel; recurrent restenosis.

MeSH terms

  • Aged
  • Angioplasty, Balloon / adverse effects
  • Angioplasty, Balloon / instrumentation*
  • Blood Flow Velocity
  • Cardiovascular Agents / administration & dosage*
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy*
  • Drug-Eluting Stents*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Female
  • Humans
  • Hyperplasia
  • Male
  • Middle Aged
  • Neointima
  • Paclitaxel / administration & dosage*
  • Prosthesis Design
  • Recurrence
  • Regional Blood Flow
  • Retreatment
  • Risk Factors
  • Stents*
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ultrasonography, Doppler
  • Vascular Patency


  • Cardiovascular Agents
  • Paclitaxel