Recurrent carotid in-stent restenosis treated with a Paclitaxel-Eluting Balloon: case report and review of literature

Abstract

IntroductionCarotid artery stenting (CAS) is a valid alternative to carotid endarterectomy with proper indications. In-stent restenosis (ISR) is a possible complication and there are multiple therapeutic options for severe ISR (>70%). The use of drug-eluting balloons (DEB) has increasing evidence as a new endovascular treatment for ISR. The authors report a case of recurrent ISR treated with a DEB. Case reportMale patient, 67 years-old, with a history of cervical radiation in 2006. In 2007, he had a stroke in the territory of the right internal carotid artery (ICA). The duplex ultrasound (DUS) showed right ICA occlusion and left ICA stenosis >70%. He underwent left CAS under filter protection, without complications. He was kept as an outpatient and in 2009 he presented ISR >70%. The patient was treated with re-stenting, without residual stenosis and had an uneventful course. In 2012, DUS revealed recurrent ISR >70%. Angioplasty with a paclitaxel-eluting balloon was performed, with distal cerebral protection, good imaging and hemodynamic results and an uneventful course. At 6 months of follow-up, the patient has no complications and no ISR documented by ultrasound. ConclusionsThe use of DEB in the treatment of ISR after CAS is an emerging strategy with promising results.