Treatment of In-stent Restenosis of the Internal Carotid Artery Using Drug-eluting Balloons.

Abstract

In-stent restenosis (ISR) following internal carotid artery (ICA) stenting is relatively common with an estimated incidence of 5%. Treatment options include repeat angioplasty with conventional or drug-eluting balloons (DEB), repeat stent angioplasty and surgical intervention. Application of DEB in ISR of the coronary and peripheral arteries is an established method; however, data on DEB treatment of ICA ISR are sparse. In this work, results from aretrospective cohort of 45patients harboring 46ICA ISR lesions treated with DEB angioplasty are presented. Clinical, procedural and imaging data from DEB angioplasty treatment of 46high-grade ICA ISR lesions in 45patients, performed between 2013 and 2021 were collected. Asingle type of DEB (Elutax, Aachen Resonance, Aachen, Germany) was used in all procedures. Imaging follow-up was performed by regular Doppler ultrasound (DUS), verified by computed tomography angiography (CTA) in cases suspicious for arecurrent ISR. Technical success was 100%. Intraprocedural and postprocedural complications were not encountered. Clinical follow-up was obtained in all patients. Recurrent stroke in the affected territory was not encountered. Arecurrent ISR following DEB treatment was confirmed by DUS and CTA in 4/46(8.7%) of the lesions and were retreated with DEB. Athird recurrent ISR occurred in asingle case (2%) and following asecond DEB retreatment there were no signs of afourth recurrence after 36months follow-up. The use of DEB angioplasty is asafe and effective treatment of ICA ISR lesions, yielding significantly better results compared to other modalities. Randomized multicenter studies are warranted.