Drug-Coated Balloon Dilation Before Carotid Artery Stenting of Post–Carotid Endarterectomy Restenosis

Abstract

Despite the small sample size and in keeping with the historically high risk of recurrent restenosis after CAS for CEA restenosis, this case series suggests that DCB dilation followed by CAS for postsurgical restenosis is feasible, safe, and may be associated with favorable clinical outcomes at midterm follow-up.

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

“…22 In the study of Piccoli et al, 14 of 18 patients were without restenosis, and the other 4 patients with mild (<30%) restenosis during followup. 24 In Pohlmann et al's study, the 1-year event-free survival (EFS) was 100%, with the rates of 2-year/3-year/5-year EFS were 83%. 25 Furthermore, for the treatment of other balloon angioplasty, all patients remained asymptomatic and without recurrent restenosis greater than 30% during 18 months of follow-up using regular balloon angioplasty.…”

“…Four studies reported the treatment of ISR with CEA. Meanwhile, among the 16 studies with PTA treatment, 7 studies reported re-PTA with stent placement, [15][16][17][18][19][20][21] 5 studies reported DCB angioplasty, [22][23][24][25][26] the other 4 studies reported the efficacy of ISR treatment with regular or cutting balloon angioplasty. [27][28][29][30] Outcomes of Treatment Efficacy…”

“…For DCB treatment, three studies described that no THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES interventional complications leading to new or aggravated neurological deficits in the patients, 22,25,26 whereas Montorsi et al reported that one patient had a left hemispheric stroke 2 months after procedure and Piccoli et al reported that one patient had a transient ischemic attack (TIA) during prolonged DCB inflation. 23,24 For the studies that intervened with the cutting balloon angioplasty, Heck reported no procedural complications or ischemic events during the follow-up period, 28 while the study of Satecci et al showed no major intraprocedural complications. 30 As to the operation treatment, two out of four studies reported that no major complications occurred.…”

Stent technology in ischemic stroke

“…42,45 It has also been described as an adjunct treatment prior to CAS in patients with restenosis after CEA. 56 One study that described DEB angioplasty for the treatment of patients with severe refractory ISR after multiple endovascular interventions demonstrated that the treatment was durable in 6 of 9 patients; in the 3 patients who developed recurrent ISR, the time to restenosis was significantly longer than after previous interventions. 30 Another promising application of balloon angioplasty is for the treatment of intracranial stenosis, especially in light of the disappointing results from the SAMMPRIS trial.…”

Successful treatment of recurrent carotid in-stent restenosis and drug-eluting balloon failure with a coronary bioresorbable vascular scaffold: A case report

“…Then, we deployed an 7.0 mm Angioguard Rx filter (Cordis), and proceeded to predilation with a 3.0 × 20 mm Trek balloon (Abbott Vascular, Santa Clara, CA, USA), followed by a 5.0 × 40 mm Aviator Plus balloon (Cordis). Despite the apparently satisfactory angiographic result, we then opted for further postdilation with a 5.0 × 80 mm Legflow paclitaxel-eluting balloon (Cardionovum, Bonn, Germany) in order to minimize the risk of recurrent hyperplasia, achieving a good final angiographic result [10] . Periprocedural antithrombotic therapy included aspirin, clopidogrel, tirofiban and unfractioned heparin, whereas discharge antiplatelet therapy consisted of lifelong aspirin and clopidogrel for 6 months.…”