Drug-Coated Balloons for Treatment of Internal Carotid Artery Restenosis After Stenting: A Single-Center Mid-Term Outcome Study

• Published in: Cardiovascular and interventional radiology Vol. 47; no. 3; pp. 291 - 298
• Main Authors: Hajiyev, Kamran, Henkes, Hans, Khanafer, Ali, Bücke, Philipp, Hennersdorf, Florian, Bäzner, Hansjörg, von Gottberg, Philipp
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2024; Springer Nature B.V
• Subjects: Angiography; Angioplasty; Arterial Interventions; Balloon treatment; Cardiology; Cardiovascular system; Carotid arteries; Carotid artery; Carotid Artery, Internal - diagnostic imaging; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - therapy; Clinical Investigation; Coated Materials, Biocompatible; Comorbidity; Constriction, Pathologic; Coronary Restenosis - etiology; Coronary Restenosis - therapy; Doppler effect; Health services; Humans; Hyperplasia; Imaging; Implants; Medical equipment; Medical imaging; Medical materials; Medicine; Medicine & Public Health; Nuclear Medicine; Patients; Radiology; Restenosis; Retrospective Studies; Risk factors; Stents - adverse effects; Tobacco; Treatment Outcome; Ultrasound; In-stent restenosis; Stroke; Carotid artery stenting; Drug-coated balloons; Carotid artery atherosclerotic disease
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-024-03663-7

Purpose Endovascular and surgical treatments of stenosis of the extracranial internal carotid artery (ICA) are common procedures, yet both introduce a risk of restenosis due to endothelial hyperplasia. Drug-coated balloons (DCBs) are designed to decrease neointimal hyperplasia, however rarely used in the neurovascular setting. This study retrospectively analyzes mid-term results of DCB-treated in-stent restenosis (ISR) of the ICA. Materials and Methods The medical history, comorbidities, and periprocedural data of patients receiving DCB treatment for > 50% ISR of the ICA after carotid artery stenting were analyzed. Follow-up after DCB treatment was performed with Doppler ultrasound. Suspicious cases were checked with CT- or MR-angiography and—if there was agreement between the modalities—validated with digital subtraction angiography. Potential risk factors for restenosis and differences in outcomes after PTA with three types of DCB balloons were evaluated. Results DCB treatment was performed in 109 cases, 0.9% of which involved in-hospital major stroke; no minor strokes occurred. A total of 17 patients (15.6%) had recurrent ISR after DCB treatment, after a mean time of 30.2 months (7–85 months). Tobacco use was significantly associated with a higher incidence of recurrent ISR. Conclusion DCB angioplasty for ISR is an effective treatment that may delay and decrease restenosis. Treating comorbidities and adopting lifestyle changes may additionally help prevent ISR. Graphical Abstract