Single-Center Experience with Carotid Stent Restenosis

Willfort-Ehringer, Andrea; Ahmadi, Ramazanali; Gschwandtner, Michael E.; Haumer, Markus; Lang, Wilfried; Minar, Erich

doi:10.1177/152660280200900308

Cited by 58 publications

(26 citation statements)

References 37 publications

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“…10,16,17,[23][24][25][26][27]29,31,35,37,39,42 Twenty-five studies used a lower restenosis threshold Ն50% to 70%, 10 -34 whereas 16 studies used a lower threshold Ͼ70% to 80% to define a restenosis. 10,11,14,15,17,19,21,[35][36][37][38][39][40][41][42][43] In Figure 1, the proportion of patients/arteries in whom/ which restenosis developed is plotted against the average follow-up time. In both groups, the data were very heterogeneous ( 2 ϭ83, dfϭ24 in the restenosis group Ն50% to 70%, PϽ0.01; and 2 ϭ39, dfϭ15 in the restenosis group Ͼ70% to 80%, PϽ0.01).…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

Gröschel

Riecker

Schulz

et al. 2005

Stroke

135

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Background and Purpose-Carotid angioplasty and stenting (CAS) has emerged as a potential alternative to endarterectomy (CEA) for the treatment of carotid artery disease. Aside from the periprocedural complication rates, the benefits of CAS will be affected by the incidence of recurrent carotid stenosis. Methods-We conducted a systematic analysis of all peer-reviewed studies reporting on the rate of restenosis (Ն50%) after CAS based on duplex ultrasound or angiography that were published between January 1990 and July 2004. We identified 34 studies that reported on a total of 4185 patients with a follow-up of 3814 arteries over a median of 13 months (range, 6 to 31 months).The ultrasound criteria and the lower thresholds for defining a recurrent stenosis were very heterogeneous. Results-The cumulative restenosis rates after 1 and 2 years were Ϸ6% and 7.5% in those studies, which used a lower restenosis threshold Ն50% to 70% and Ϸ4% in the first 2 years after CAS in those studies, which used a lower restenosis threshold Ͼ70% to 80%. Conclusions-In reviewing the current literature, the early restenosis rates after CAS compare well with those reported for CEA. However, this analysis of the peer-reviewed literature also indicates that the early restenosis rates after CAS might be higher than previously suggested in observational surveys. Therefore, an active follow-up of all stented arteries seems to be warranted. Moreover, the bulk of endovascular data are derived from small studies with short follow-up periods so that the long-term durability of CAS still needs to be established in large trials.

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Section: Resultsmentioning

confidence: 99%

“…10,11,[15][16][17]19,21,39,40,42,43 In both groups, Ϸ46% of all restenoses occurred within the first 6 months, Ϸ25% within 6 to 12 months, and 29% beyond the first year.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

Gröschel

Riecker

Schulz

et al. 2005

Stroke

135

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“…The synthetic layer of stent grafts is thought to act as a mechanical barrier allowing only minimal intimal hyperplasia. End-stent stenosis is more common with covered stents compared with conventional stents 16 and it has been suggested that it primarily occurs adjacent to a bend or kink 17 .…”

Section: Casementioning

confidence: 99%

In-Stent Stenosis Following Covered Stent-Graft Placement

Flood

Bussiére

Teefy

et al. 2009

Can. j. neurol. sci.

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Internal carotid artery (ICA) covered stent-grafts are increasingly utilized for the endovascular management of traumatic carotid pseudoaneurysms 1 " 9 , carotid-cavernous fistulas 1012 , large petrous/cavernous carotid aneurysms 12 and carotid blow-out syndrome 7 . Early covered stent grafts were selffabricated using polytetrafluoroethylene or autologous vein mounted onto bare metal stents. Pre-mounted balloon expandable or self-expanding stent-grafts are now commercially available. Covered stents provide an alternate treatment option for high surgical risk or inaccessible lesions or when observation and anticoagulation are less than desirable. Potential advantages of covered stent grafts include minimal invasiveness, shorter hospital stays, lower cost and less post-procedural pain. Caution in the application of this relatively new technology and careful follow-up are required, however, as is illustrated by two patients with internal carotid artery stenosis following covered stent-graft placement. Case IA 24-year-old previously healthy right-handed woman was the belted driver in a vehicle roll-over. She sustained multiple injuries including fractures of the odontoid process of C2 and the left transverse process of C7. A computed tomogram (CT) head performed at the time of admission was unremarkable. The patient was sedated, intubated and treated with hypothermia according to the institutional protocol. As the sedation dissipated 24-hours later, the patient was found to be aphasic with mild right-sided face and arm weakness. A repeat CT head demonstrated a subacute left fronto-temporal infarct and CT angiography revealed left internal carotid artery (ICA) occlusion, presumed to be secondary to arterial dissection. Antiplatelet therapy was initiated at this time.The patient made a good functional recovery with significant improvement in speech and complete recovery of motor function. A one-month follow-up CT angiogram demonstrated recanalization of the left ICA but development of a pseudoaneurysm at the level of the first cervical vertebrae. Serial noninvasive angiography over three months demonstrated progressive enlargement of the pseudoaneurysm and consequently the patient was referred for endovascular management to prevent its continued expansion and decrease the future risk of a recurrent ischemic event.Given the angio-architecture of the pseudoaneurysm, covered stent graft placement or vessel occlusion were considered as the safest and effective treatment options. An approach preserving

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“…In-stent restenosis (ISR) is a recognized complication of CAS, with severe restenosis (>70%) occurring in 3–5% of patients. 1 2 3 4 5 Restenosis after CAS is often asymptomatic, but is not always benign and may progress to asymptomatic occlusion or present with ischemic symptoms or stroke. 1 2 3 4 5 While the scope of future applications for CAS will depend on the results of pivotal clinical trials, there is no argument that CAS will continue to have a role in many patients, and that physicians need to understand the best management and treatment strategies for patients with severe in-stent restenosis.…”

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confidence: 99%

Results of cutting balloon angioplasty for carotid artery in-stent restenosis in six patients: description of the technique, long-term outcomes, and review of the literature

Heck¹

2009

J NeuroIntervent Surg

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Single-Center Experience with Carotid Stent Restenosis

Abstract: Carotid stent restenosis, which occurs rarely after 1 year, can be treated safely by further percutaneous interventions.

Cited by 58 publications

References 37 publications

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

Systematic Review of Early Recurrent Stenosis After Carotid Angioplasty and Stenting

In-Stent Stenosis Following Covered Stent-Graft Placement

Results of cutting balloon angioplasty for carotid artery in-stent restenosis in six patients: description of the technique, long-term outcomes, and review of the literature

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