<p>This article presents a successful clinical case of the endovascular treatment of stenosis of the right internal carotid artery through the left radial access in a patient with multifocal atherosclerosis with the occlusion of both iliac arteries and the right radial artery. Transfemoral access is the conventional access route for carotid stenting. However, this may be problematic because of peripheral vascular disease and numerous anatomical variations of the aortic arch and cervical arteries. Bleeding in the puncture area is the most common complication after carotid artery stenting (CAS) via transfemoral access. The elimination of such complications has been well demonstrated via transradial access in patients undergoing coronary interventions. Thus, transradial access has been evaluated as an alternative strategy for carotid stenting. Currently, the CAS procedure is a fairly routine practice in many centres involved in the treatment of this pathology; however, a small percentage of patients who are contraindicated in carotid endarterectomy who lack standard puncture access to the arteries and have a complex anatomy of the brachiocephalic arteries still remain. In such cases, the question regarding the feasibility of the CAS procedure using non-standard puncture approaches and various techniques for the catheterisation of the brachiocephalic arteries remains relevant. In this case, the left radial access and the Catheter Looping and Retrograde Engagement Technique were used for the catheterisation of the right common carotid artery because of the anatomical features, the patient’s refusal toward carotid endarterectomy, and the lack of standard access (femoral and right radial). A distal protection system was used for the brain.</p><p>Received 18 July 2019. Revised 15 August 2019. Accepted 19 August 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Operator: R.R. Khafizov <br />Collection and processing of material: R.R. Khafizov, I.A. Idrisov<br />Writing original draft: R.R. Khafizov<br />Editing: E.E. Abkhalikova, T.N. Khafizov</p>

Background. Carotid artery restenosis is a rare complication of carotid stenting. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) reveals an in-stent restenosis rate of 0–6 %, a fairly low value given an extensive study sampling of patients. Restenosis still lacks an adequate explanation in endovascular carotid surgery. Intravascular ultrasound visualisation, drug-coated balloons, stent reimplantation or reconstructive surgery have actively been used since relatively recently to tackle restenosis. Drug-coated balloons may fail in certain cases due to hampered restenosis angioplasty in a markedly rigid neointimal hyperplasia. Surgical reconstruction also possessed drawbacks, mostly due to obstacles in the stent removal and the procedure infeasibility in high-risk surgical patients.Materials and methods. The article describes a clinical case of stent-in-stent restenosis correction with drug-coated balloon-expandable re-stenting of right internal carotid artery and a long-term prognosis estimation with optical coherence tomography.Results and discussions. This tactic was adopted due to haemodynamically and clinically significant internal carotid artery restenosis, the patient’s denial of carotid endarterectomy and insufficiently effective balloon angioplasty. The choice of the correction technique was conclusive basing on a negative stent deformation testing that showed the lack of deforming stress factors at internal carotid artery restenosis. Intravascular imaging greatly enhances our ability to understand and assess endovascular processes.Conclusion. We consider clinically significant restenoses in previously stented carotid arteries as requiring further research effort, with the clinical case presented describing an individual solution.

Conclusions:In our real-world practice, reasonable results were obtained concerning minor periprocedural stroke rates. The higher minor stroke rates in CAS procedures are according to other literature. With no periprocedural major stroke or death, a good result was obtained. Even in the specific Belgian situation, acceptable results can be obtained with a CAS procedure in a high-risk population for CEA.

Peripheral arterial atherosclerosis, i.a., in renal arteries, is quite a regular pathology. Despite long clear aetiology and pathogenesis, a unified systemic management approach in such patients is still lacking. We have reviewed and analysed classical academic resources and scientific record databases (Cochrane Library, PubMed and Google Scholar) in the topic and engaged self-experience on the observation and treatment of patients with stenotic peripheral arteries. Ultrasonic duplex scanning (USDS) of renal arteries is the most accessible and cost-effective screening method to date. Among non-invasive techniques are magnetic resonance imaging (MRI) and contrast-enhanced multislice computed tomography (MSCT). Subtraction angiography remains the gold standard for deciding a surgical treatment, and intravascular diagnostic capacities grow as well. Today’s interventional radiology is powered by fractional flow reserve (FFR) measurement, intravascular ultrasound (IVUS) and optical coherence tomography (OCT).The management of patients with narrowed renal arteries remains relevant and requires further insight. A continuing accumulation and synthesis of experience in diagnosis and treatment of peripheral arterial stenosis is imperative. Current medicine relies on high technologies in the discovery and treatment of peripheral arterial stenosis. The quality of patient management directly relates to the hospital technical and financial level, the personnel competence and mastery of current state-of-the-art.