Purpose: To evaluate the safety and efficacy of drug-eluting balloons (DEB) for the treatment of in-stent restenosis (ISR) after carotid artery stenting (CAS). Methods: Among 830 consecutive patients undergoing CAS between November 2001 and June 2012, significant ISR (>80% stenosis) occurred in 10 (1.2%) asymptomatic patients. Angioplasty with DEB treatment was performed in 7 patients (6 internal and 1 common carotid arteries) at a mean of 20.9±19.4 months (median 12.1) after CAS. Intravascular ultrasound (IVUS)-guided predilation with distal cerebral protection was carried out with a cutting balloon followed by inflation of a DEB with a 1:1 stent-to-balloon size ratio. Results: Technical/procedural success was achieved in all cases. Angiographic stenosis decreased from 83%±5% to 18%±6%. At IVUS evaluation, minimal lumen area increased from 3.19±1.73 to 12.78±1.97mm2 (p=0.0001), stent area was unchanged (from 17.36±4.36 to 17.52±4.34 mm2, p=0.70), and the restenosis area decreased from 13.58±5.27 to 4.71±3.06 mm 2 (p=0.0005). At amean follow-up of 13.7±1.5months (median 13.7), 1 patient had a minor stroke ipsilateral to the ISR vessel 2 months after DEB treatment; the stent was widely patent on duplex ultrasound and angiographic images. Overall, the average PSV decreased from 4.0±1.0 to 0.9±0.1 m/s (p=0.0001). At 6 and 12 months, PSVs after DEB treatment were significantly lower compared to those assessed at comparable intervals after CAS. Conclusion: The use of DEBs to treat ISR after CAS shows promising acute and midterm results.
- Carotid artery stenosis
- Carotid artery stenting
- Drug-eluting balloon
- In-stent restenosis
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging