Poor durability of carotid angioplasty and stenting for treatment of recurrent artery stenosis after carotid endarterectomy: An institutional experience

Purpose: Recurrent stenosis after carotid endarterectomy (CEA) is often reg arded as an optimal application of carotid artery angioplasty and stenting (CAS). The extended durability of CAS for recurrent carotid artery stenosis after CEA is unknown. We present the intermediate-term surveillance result s for all eight CAS procedures performed over a 28-month period at a single tertiary referral center. Methods: Patients had recurrent carotid stenosis after CEA, whether symptomatic or asymptomatic, of 80% to 99% stenosis on preprocedural carotid duplex scan examination. Uncovered, self-expanding me tal stents, in conjunction with angioplasty, were used in all patients. Bas eline and scheduled interval follow-up duplex ultrasound scan was used to a ssess intrastent restenosis. Further angiography was reserved for those pat ients obtaining additional intervention. Results:One transient ischemic attack was observed 1 day after the procedur e, and no cerebral infarct occurred. All patients had angiographic resoluti on of the stenosis and postprocedural duplex scan studies without residual stenosis. Subsequent interval surveillance duplex scan examinations reveale d significant (60%-79%) to critical (80%-99%) recurrent stenosis in six (75 %) of eight patients, two of whom went on to further interventions. Of thos e with intrastent restenosis, four (75%) progressed to critical (80%-99%) s tenosis. Mean follow-up was 20.2 months (range, 12-37 months). The two lesi ons that have not yet shown restenosis are those with the shortest follow-u p interval, each at 12 months. Conclusions: In contrast to the optimistic claims in other series, this lim ited series suggests that angioplasty with stenting for recurrent carotid a rtery occlusive disease after CEA, although relatively safe in the short te rm, has significant limitations in terms of durability of results.