Carotid endarterectomy for treatment of carotid in-stent restenosis: long-term follow-up results and surgery experiences from one single centre

• Published in: Stroke and vascular neurology Vol. 2; no. 3; pp. 140 - 146
• Main Authors: Yu, Le-Bao, Yan, Wei, Zhang, Qian, Zhao, Ji-Zong, Zhang, Yan, Wang, Rong, Shao, Jun-Shi, Zhang, Dong
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2017; BMJ Publishing Group
• Subjects: Aged; Aneurysms; Angioplasty; Asymptomatic; Beijing; Cardiovascular disease; Carotid arteries; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - therapy; Chronic illnesses; Device Removal - adverse effects; Diabetes; Endarterectomy, Carotid - adverse effects; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Female; Humans; Hypertension; Male; Medical imaging; Middle Aged; Neurosurgery; Original; Patients; Postoperative Complications - etiology; Recurrence; Retrospective Studies; Risk Factors; Stents; Stroke; Surgery; Time Factors; Treatment Outcome; Ultrasonic imaging; Beijing; Stent removal; Carotid endarterectomy (CEA); In-stent restenosis (ISR); Carotid artery stenting (CAS)
• ISSN: 2059-8688; 2059-8696
• DOI: 10.1136/svn-2017-000089

ObjectiveFew studies have reported the surgical treatment of carotid in-stent restenosis (ISR), more data and longer follow-up are needed. We describe the surgical treatment of ISR by standard carotid endarterectomy (CEA) with stent removal, including long-term follow-up in 10 patients from our centre.MethodsTen patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed, including nine symptomatic and one asymptomatic ISR of at least 70% with mean age 67.3, the median time between carotid artery stenting and CEA was 17 months (range, 2–54 months).ResultsStandard CEA with stent removal was performed in all 10 patients without much technical difficulty (9 male and 1 female, mean age 67.3). Two cases were performed in hybrid operation room. There were a total of three complications that happened in three patients (30%) respectively. An asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without intervention. In the second case, dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography, and another stent was implanted. The patient sustained temporary hypoglossal nerve dysfunction postoperatively. The third patient suffered cerebral hyperperfusion with complete recovery when discharged. No neurological complications occurred in other seven patients. After follow-up of 25 months (range, 11–54 months), one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation; in one patient occurred recurrent symptomatic restenosis (90%) 1 year later; all other patients remained asymptomatic and without recurrent restenosis (>50%) by follow-up carotid ultrasound or CT angiography.ConclusionIt seems that CEA with stent removal is a reasonable choice, by experienced hand, for symptomatic ISR with higher but acceptable complications. The indication of stent removal for asymptomatic ISR needs further observation.