NEW YORK — While procedural complication rates for carotid artery stenting for restenosis after previous ipsilateral carotid endarterectomy are very low, the rate of in-stent restenosis is high and appears to be an ongoing process, according to data presented at the Veith symposium on vascular medicine sponsored by the Cleveland Clinic.
Technical success of carotid artery stenting for restenosis was 100% in one study involving 57 procedures in 55 patients. However, survival without in-stent restenosis fell from 93% at 1 year to 76% at 4 years, said Dr. Gerrit de Borst, of the University Medical Center, Utrecht, the Netherlands.
“Our data demonstrate that restenosis is an ongoing process,” said Dr. de Borst.
The researchers followed 55 patients (63% men, mean age 70 years) who underwent 57 carotid artery stent procedures for restenosis after prior ipsilateral carotid endarterectomy between 1998 and 2004. Thirty-four Wallstents, 17 Cordis stents, and 6 other stents were used. Patients underwent serial duplex scanning and clinical evaluation at 3 and 12 months, and yearly thereafter.
The mean interval between the two procedures was 83 months. Only nine patients had symptomatic high-grade restenosis. The procedure was performed using local anesthesia and femoral access.
No deaths or strokes occurred during the procedure. However, two patients had transient ischemic attacks during the procedure. Both patients recovered prior to discharge. One patient had a groin hematoma that was treated conservatively.
Mean follow-up was 36 months. In that time, there were three deaths (because of cardiac reasons). One patient had a transient ischemic attack at 30 months, and one had a minor stroke at 60 months.
Eleven patients had restenosis defined as at least 50% during the follow-up period. Of these, three were detected at 3 months, three at 12 months, two at 24 months, one at 36 months, one at 48 months, and one at 60 months. This indicates that “restenosis is not a process that only occurs early after stent placement,” said Dr. de Borst.
Six patients had to have an additional procedure for restenosis. Three had carotid endarterectomy with stent removal. The other three had percutaneous transluminal angioplasty. Reintervention-free survival was 96% at 1 year, 94% at 2 years, 90% at 3 years, and 84% at 4 years.
Dr. de Borst disclosed that he has no conflicts of interest.