Abstract
Background Associated with increasing use of carotid artery stenting (CAS), the occurrence of
late complications is likely to rise. The surgical strategies of CAS complications
like in-stent-restenosis (ISR) are not yet to be determined. Thus different situations
require individual operative techniques.
This study contains our experience in the operative management for significant recurrent
carotid stenosis following angioplasty and stent placement. As a novel strategy, we
report successful stent removal and endarterectomy with eversion technique (ECEA).
Methods Four complete stent removals were performed in three patients with three different
techniques and anesthesiological protocols (general anesthesia n = 1, regional anesthesia n = 3). First stent removal with excision of common carotid artery (CCA) and internal
carotid artery (ICA) following interposition of CCA-ICA with Dacron graft (n = 1). Second carotid endarterectomy with stent removal followed by patch angioplasty
(n = 2). Third stent removal and ECEA and thus biological reconstruction without synthetic
material (n = 1). Mean operative time was 131 minutes (±19.25). Mean follow-up was 11.5 months
(±7.7). As postoperative complications, one major bleeding, one transient neurologic
deficit and one postoperative neck hematoma, requiring operative revision, occurred.
During a 30-day follow-up, all patients made an uneventful recovery. There was no
evidence of restenosis or neurological deficit during the following postoperative
controls. A review and comparison of the current surgical management and strategies
in the treatment of ISR was also performed (Pubmed).
Conclusion Surgical treatment of ISR after CAS is beneficial but in literature infrequently
reported. We could demonstrate in this study that even stent removal and ECEA is feasible
and safe with durable outcome. The current strategies are therefore extended as well
as the reported performance under regional anesthesia. However, surgical treatment
in ISR remains a challenging option and larger series are highly recommended.
Keywords
carotid arteries - endovascular procedures/stents - except PCI - restenosis - reoperation
- stents - surgery - complications
