NorthPoint Domain

Neuroscience: After Stenting, Carotid Endarterectomy Effective Revascularization Technique

There are potential cerebral and bleeding complications

Carotid endarterectomy with stent explantation is an effective and durable treatment for in-stent restenosis after carotid angioplasty and stenting, according to the results of a small study published recently in the Journal of Vascular Surgery.

Carotid angioplasty and stenting (CAS) is an increasingly popular alternative to carotid endarterectomy (CEA), but is associated with a higher risk of periprocedural adverse events. Specifically, in-stent restenosis (ISR) is three times more common than after CEA. There are several therapeutic options but little data on follow up. The authors of the current study therefore sought to assess long-term outcome of ISR treatment. They analyzed 15 patients who were treated by a surgical intervention because of symptomatic or hemodynamically significant ISR after CAS between January 1996 and December 2009 at one of three Dutch vascular centers. Mean age was 64.5 years.

All participants underwent standard CEA with stent removal. Median time between CAS and CEA was 18.3 months. One patient had an intraoperative minor ischemic stroke with complete recovery during the first postoperative days. There were no neurologic complications in the other 14 patients. Two neck hematomas occurred, however, and both were successfully evacuated during reoperation. After a median follow up of 21 months, all participants remained asymptomatic, and no reinterventions were required. No patients developed recurrent restenosis of greater than 50 percent on duplex ultrasound scanning. “Surgeons may consider CEA as an acceptable and durable alternative to endovascular reintervention when revascularization is indicated,” the authors conclude.

Source: Reichmann BL, van Laanen JHH, de Vries JPM, et al. 2011. Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting. Journal of Vascular Surgery 54:87-92.