Response to ‘Re. Carotid Endarterectomy with Stent Removal in Management of In-stent Restenosis: A Safe, Feasible, and Effective Technique’

Abstract

The paper describes the efficacy of carotid endarterectomy (CEA) with stent removal in the management of symptomatic in-stent restenosis (ISR). Because of the limitations of the currently available data, we agree that the bias may be a little bit high in the analysis. However, the statistics in this paper may, at least in part, reflect the feasibility and effect of CEA with stent removal. We do not agree with the reader that “in three patients (7.3%) removed stent were replaced with graft, and endarterectomy was not the performed procedure”. Actually, all these three cases underwent CEA with stent removal. The original descriptions in the references are as follows: (1) “After stent removal simultaneously a CEA was performed”.1Jost D. Unmuth S.J. Meissner H. Henn-Beilharz A. Henkes H. Hupp T. Surgical treatment of carotid in-stent-restenosis: novel strategy and current management.Thorac Cardiovasc Surg. 2012; 60: 517-524Crossref PubMed Scopus (14) Google Scholar (2) “In 2 patients, after stent removal a standard CEA with interposition of a 6 mm polytetrafluoroethylene (PTFE) graft was necessary”.2Raithel D. Complications of carotid artery stenting.J Cardiovasc Surg (Torino). 2005; 46: 261-265PubMed Google Scholar So these three patients were included in our paper. The optimal treatment for ISR has not been determined. Carotid graft replacement (CGR) is also an option. We had mentioned in our paper some of the main reasons why surgeons chose to perform endovascular therapy or other surgical strategies instead of CEA. We reported the first case of CEA with stent removal in the management of ISR in our hospital. Since then, we have performed another five cases through CEA with stent removal. The outcomes are encouraging. We will share the surgical experiences in a future paper. We agree with the reader that CEA with stent removal, patch angioplasty, graft replacement, carotid stenting, or some other technique in treatment of ISR should be compared, to establish the optimal treatment of ISR. Re. ‘Carotid Endarterectomy with Stent Removal in Management of In-stent Restenosis: A Safe, Feasible, and Effective Technique’European Journal of Vascular and Endovascular SurgeryVol. 48Issue 1PreviewWe read with interest the paper by Zheng et al.1 The article covers the very interesting topic of how to treat challenging pathology and concluded, very liberally, that carotid endarterectomy (CEA) with stent removal is a safe, feasible, and effective procedure for the treatment of in-stent restenosis (ISR).1 Such an optimistic conclusion is difficult to read, even at the end of papers reporting the results of randomized controlled trials (i.e., the highest level of evidence). According to randomized controlled trials, carotid patch angioplasty has shown better results than primary closure, as performed in the article discussed. Full-Text PDF Open Archive