THE ROLE OF ENDOVASCULAR SURGERY IN CAROTID RESTENOSIS

Purpose: To report the immediate and long-term outcome of intraoperati ve balloon angioplasty for the treatment of recurrent disease in the i nternal carotid arteries (ICAs). Methods: Three patients (2 males, 1 f emale; ages 53 to 70 years) presented with > 80% restenotic lesions (b ilateral in one patient) at the distal aspect of a previous carotid en darterectomy. Two patients exhibited hemianopia, while the third was a symptomatic but had a contralateral ICA occlusion. All four lesions ap peared smooth and fibrous on ultrasonography and were located high in the ICA. The location and morphology of the lesions made balloon angio plasty a more potentially successful treatment option. Results: Throug h open access to the common carotid artery, the lesions were approache d and dilated under fluoroscopic guidance with monitoring of evoked po tentials. The lesions were successfully dilated as determined by contr ol arteriography, and no complications were encountered. Over a follow -up period extending to 18 months in one patient and 24 months in the other two, ultrasound imaging and arteriography have shown no restenos is at any treatment site. Conclusions: Although caution is prudent whe n dealing with lesions in the cervical arteries, balloon angioplasty m ay have a role in treating surgically inaccessible restenotic carotid lesions that demonstrate a low potential for embolic complications. Mo re experience with this technique will be required before widespread a pplication of balloon angioplasty in the cervical vessels can occur.