Document Detail


Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting.
MedLine Citation:
PMID:  21315546     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Carotid angioplasty and stenting (CAS) has emerged as an alternative for carotid endarterectomy (CEA) in the prevention of stroke. The benefit of the procedure, however, is hampered by a suggested higher incidence of in-stent restenosis (ISR) for CAS relative to CEA during follow-up. ISR management remains a challenge for clinicians. In this observational retrospective analysis, we evaluated the operative management of ISR by standard CEA with stent removal, including midterm follow-up in 15 patients.
METHODS: The present analysis included 15 patients from three Dutch vascular centers who underwent CEA for symptomatic (n = 10) or hemodynamically significant (≥80%) asymptomatic ISR (n = 5). Median time between CAS and CEA was 18.3 months (range, 0-51 months).
RESULTS: Standard CEA with stent removal was performed in all 15 patients. A Javid shunt was used in two procedures. One patient sustained an intraoperative minor ischemic stroke, with complete recovery during the first postoperative days. No neurologic complications occurred in the other 14 patients. Two patients required a reoperation to evacuate a neck hematoma. There were no peripheral nerve complications. After a median follow-up of 21 months (range, 3-100 months), all 15 patients remained asymptomatic and without recurrent restenosis (≥50%) on duplex ultrasound imaging.
CONCLUSION: CEA with stent explantation for ISR after CAS seems an effective and durable therapeutic option, albeit with potential cerebral and bleeding complications, as in this study. The optimal treatment for carotid ISR, however, has yet to be defined.
Authors:
Boudewijn L Reichmann; Jorinde H H van Laanen; Jean-Paul P M de Vries; Johanna M Hendriks; Hence J M Verhagen; Frans L Moll; Gert Jan de Borst
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2011-02-11
Journal Detail:
Title:  Journal of vascular surgery     Volume:  54     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-04     Completed Date:  2011-09-06     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  87-92     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty / adverse effects,  instrumentation*
Brain Ischemia / etiology
Carotid Stenosis / physiopathology,  surgery,  therapy*,  ultrasonography
Device Removal
Endarterectomy, Carotid* / adverse effects
Female
Hemodynamics
Humans
Male
Middle Aged
Netherlands
Recurrence
Reoperation
Retrospective Studies
Stents*
Stroke / etiology
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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