Surgical management of post carotid artery stenting restenosis

Abstract

To discuss the feasibility, safety and effectiveness of surgical management of post carotid artery stenting (CAS) restenosis, mainly focusing on the surgical options and indications. This study represented retrospective analysis of 3 kinds of surgical managements of 21 patients with symptomatic post CAS restenosis from April 2012 to April 2014. Patch carotid endarterectomy (pCEA), Eversion carotid endarterectomy (eCEA) or carotid excision and graft interposition (CEGI) was selected to remove the stent and reconstruct the blood flow, based on the preoperative imaging results and intraoperative adhesion degree. Use of carotid shunt, blood loss, operative time, carotid artery cross-clamp time and other data were recorded. Patients were followed for improvement of symptoms, complications and restenosis. Eleven, 4 and 6 patients received pCEA, eCEA or CEGI respectively. All the stents were successfully removed. Shunts were deployed in 14 cases. The mean bleeding was (152.6 ± 38.0) ml, the mean operation time was (100.7 ± 34.8) min and the mean carotid artery clamping time was (29.1 ± 4.6) min. In the early postoperative period, there were no infection, strokes, cranial nerve injury, myocardial infarction or mortalities. One patient developed neck hematoma, while 2 patients had the symptoms of hyperperfusion such as headache, irritability and multi-lingual but no intracranial hemorrhage happened according to the brain CT scan, who all fully recovered within 3 days. Within a median follow-up of (13.2 ± 4.3) months, no strokes, myocardial infarctions or recurrent restenosis (> 50%) on duplex ultrasound imaging or CTA was discovered except for 1 patient who died of lung cancer. Surgical management to remove the stent and reconstruct the blood flow, which offered new options in the treatment of post CAS restenosis, with its initially confirmed simplicity, feasibility, safety and validity.