Carotid artery angioplasty and stent placement for recurrent stenosis

Abstract

The use of endovascular management for recurrent carotid artery (CA) stenosis is rapidly expanding due to the increased surgical risk associated with repeated carotid endarterectomy (CEA). Carotid artery angioplasty and stent placement for recurrent CA stenosis offers a less invasive strategy with fewer procedural complications and may provide a more durable treatment. The authors report on their experience with this procedure in the management of recurrent CA stenosis. A retrospective review was performed to evaluate clinical and ultrasound imaging outcomes after CA angioplasty and stent placement. Twenty-three vessels in 22 patients with severe recurrent stenosis (> 80%) post-CEA were treated with balloon angioplasty and stent placement without distal protection. There were no perioperative neurological or cardiac complications in this series. Over a mean follow-up period of 36 months, one patient (5%) suffered recurrent stenosis requiring retreatment with angioplasty alone. The use of CA angioplasty and stent placement provides a safe and effective treatment for recurrent CA stenosis. The use of drug-eluting and/or bioactive stents in the future will likely further improve the efficacy of this procedure for recurrent CA stenosis.