The Myth of Restenosis After Carotid Angioplasty and Stenting
BACKGROUND AND PURPOSE: Reported rates of in-stent restenosis after carotid artery stenting (CAS) vary, and restenosis risk factors are poorly understood. We evaluated restenosis rates and risk factors, and compared patients with 'hostile-neck' carotids (a history of ipsilateral neck surgery or irradiation) and atherosclerotic lesions. METHODS: Demographic, clinical, and radiological characteristics of patients undergoing cervical CAS between 1995 and 2010 with at least 1â€…month of follow-up were reviewed. Patients with substantial (â‰¥50%) radiographic restenosis were compared with those without significant restenosis to identify restenosis risk factors. RESULTS: The analysis included 121 patients with 133 stented vessels; 91 (68.4%) lesions were symptomatic. Indications for stent placement included hostile-neck lesions, substantial surgical comorbidities, inclusion in a randomized carotid stenting trial, acute carotid occlusion, tandem stenosis, large pseudoaneurysm, high carotid bifurcation, and contralateral laryngeal nerve palsy. Procedures were technically successful in all but one lesion (99.2%). Perioperative stroke occurred in four cases (3.0%). Mean follow-up was 38â€…months (range 1-204â€…months), during which 23 vessels (17.3%) developed restenosis. Hostile-neck carotids (n=57) comprised 42.9% of all vessels treated and were responsible for 15 of 23 restenosis cases, resulting in a significantly higher restenosis rate than that of primary atherosclerotic lesions (26.3% vs 10.5%, p=0.017). By univariate analysis, the presence of calcified plaque was significantly associated with the incidence of in-stent restenosis (p=0.02). CONCLUSIONS: Restenosis rates after carotid angioplasty and stenting are low. Patients with a history of ipsilateral neck surgery or irradiation are at higher risk for substantial radiographic and symptomatic restenosis.
Journal of neurointerventional surgery
Digital Object Identifier (DOI)
Moon, Karam; Albuquerque, Felipe C.; Levitt, Michael R.; Ahmed, Azam S.; Kalani, M. Yashar S.; and McDougall, Cameron G., "The Myth of Restenosis After Carotid Angioplasty and Stenting" (2016). Neurosurgery. 457.