Carotid artery interventions for restenosis after prior stenting: is it different from interventions of de novo lesions? Results from the carotid artery stent (CAS)—registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Abstract

Patients treated with Re-CI for repeat stenoses after prior CAS represent 2.5% of current CAS patients. Although representing a subgroup with more concomitant diseases, Re-CI seems to be associated with lower event rates as compared to CAS for de novo lesions.

A Review on the Comparison of Different Treatments for Carotid In-Stent Restenosis

“…Furthermore, the degree of stenosis at which revascularization for symptomatic lesions is favored is also unclear. Because carotid ISR lesions appear less embologenic, 43 it is plausible that intervention may be reserved for only high-grade stenoses rather than for all lesions >50%. 32 As to the treatment options of carotid ISR, still limited evidence was presented and the ideal therapeutics have not been identified, with the choice of re-PTA/stenting, repeated balloon angioplasty (regular, cutting or DCB), and surgical treatment (CEA with stent removal, carotid artery bypass, or interposition graft).…”

Percutaneous intervention for carotid in-stent restenosis does not improve outcomes compared with nonoperative management

“…C-ISR is a rare phenomenon after carotid stenting. [3][4][5][6][7][8][9][10] This is likely due to the relatively short stents placed in a high-flow region of the vasculature. Interventions were performed for these lesions in the past because of the uncertainty surrounding stent occlusion and the relative safety of interventions for C-ISR.…”

“…conservative management, citing the decreased embologenic potential of restenotic lesions. 10 Studies describing the safety and efficacy of revascularization for C-ISR all share the common flaw of a lack of a nonoperative arm for comparison. [4][5][6][7][8][9][10][11][12] This is particularly germane in asymptomatic lesions because of strides made in optimal medical management in recent years.…”

“…10 Studies describing the safety and efficacy of revascularization for C-ISR all share the common flaw of a lack of a nonoperative arm for comparison. [4][5][6][7][8][9][10][11][12] This is particularly germane in asymptomatic lesions because of strides made in optimal medical management in recent years. [13][14][15] Moreover, series describing the safety of revascularizations for C-ISR also all suffer from publication bias, which may falsely minimize the risks associated with revascularizations for C-ISR.…”

“…[13][14][15] Moreover, series describing the safety of revascularizations for C-ISR also all suffer from publication bias, which may falsely minimize the risks associated with revascularizations for C-ISR. [4][5][6][7][8][9][10][11][12]16 In addition, studies describing outcomes after revascularizations for C-ISR have limited study bases, with abbreviated follow-up. 16 Whereas stroke rates have decreased in the last decade, the U.S. population is aging with a persistently high burden of cardiovascular risk factors.…”