In-Stent Restenosis After Carotid Artery Stenting: From Diagnosis to Treatment

*Giuseppe Di Gioia, Domenico Scordino, Cosimo Marco Campanale, Marco Miglionico, Antonio Creta, Claudio Proscia, Laura Ragni, Iginio Colaiori, Germano Di Sciascio

Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
*Correspondence to dottgiuseppedigioia@gmail.com

Disclosure: The authors have declared no conflicts of interest.
Received: 12.02.2016 Accepted: 29.04.2016
Citation: EMJ. 2016;1[3]:118-124.

Abstract

Although carotid artery stenting is a safe and effective treatment for preventing ischaemic stroke in significant carotid atherosclerotic disease, it can be complicated by in-stent restenosis (ISR). Factors involved in the ISR process are both mechanical and patient-related, but the most important is the neointimal thickening within stent struts, leading to lumen reduction. Overall incidence of carotid ISR is low and related embolic risk seems to be lower than native disease. Digital subtraction angiography is the gold standard for diagnosis. Nowadays, Doppler ultrasound should be considered the first-line investigation, due to its non-invasiveness and reproducibility. Computed tomography angiography remains useful when Doppler ultrasound is inconclusive. Indication and modality of treatment of ISR are still debated: both surgery (carotid endarterectomy with stent removal in most cases) or interventional procedures such as percutaneous transluminal angioplasty with simple balloon, cutting-balloon, drug-eluting balloon, and stenting, showed safety and efficacy in follow-up. Surgery is currently reserved for selected cases. Carotid ISR is an overall rare complication which can be easily identified at routine follow-up. This paper is a literature review and state-of-the-art assessment of ISR, clinical features, diagnosis, and treatment.

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