Skip to main content Accessibility help
×
Home

A Review on the Comparison of Different Treatments for Carotid In-Stent Restenosis

  • Chizhong He (a1), Shuo Wang (a1), Xiaohong Zhou (a1) and Zhexian Yang (a1)

Abstract:

Different treatment options for carotid in-stent restenosis (ISR) have been reported with good outcome, including carotid endarterectomy (CEA), repeated carotid angioplasty stenting (CAS) and percutaneous transluminal angioplasty (PTA) with drug-coated balloons (DCBs). However, the optimal treatment option for ISR has not yet been determined. A systematic literature search was performed in the databases of Medline, Embase, Cochrane library, and unpublished data from clinicaltrials.gov from 1990 to March 1, 2019. Studies were enrolled if they reported treatment strategies for carotid ISR treatment and met the inclusion criteria. After study inclusions, data were extracted and summarized. Totally 25 cross-sectional studies were included, containing 5 comparative studies, 16 studies using repeated PTA, and 4 studies adopting CEA treatment. Our study summarized the current available data, showing that all the studies could effectively relieve the carotid ISR by significantly improving the angiographic stenosis and decreasing the peak systolic velocity values. Meanwhile, CEA treatment had the best long-term effects in relieving restenosis, while re-PTA with stenting/balloon angioplasty had a certain rate of restenosis, ranging from 33% to 83%. Furthermore, re-PTA/stenting and balloon angioplasty treatment had less complications compared with CEA. Also, we analyzed the risk factors that might affect the long-term prognosis of carotid ISR patients. The therapeutic measures for carotid ISR had their own features, with CEA had the highest efficacy while re-PTA/stenting and balloon angioplasty were with less complications. More large-scale comparative clinical studies are needed to further ascertain the best strategies.

Examen comparatif entre divers traitements de la resténose carotidienne sous-tendant la pose d’endoprothèses. Dans le cas de la resténose carotidienne, la littérature scientifique signale différentes possibilités de traitement sous-tendant la pose d’endoprothèses (stents). Ces traitements s’accompagnent de bons résultats et incluent l'endartériectomie carotidienne, l’angioplastie répétée et l’angioplastie percutanée transluminale au moyen de ballonnets actifs (drug-coated balloons). Cela dit, on n’est pas encore parvenus à déterminer une possibilité idéale de traitement. Nous avons effectué une recension systématique de la littérature scientifique au moyen des bases de données suivantes : MEDLINE, Embase et Cochrane Library. Nous avons également fait appel à des données jamais publiées tirées du site Internet clinicaltrials.gov et comprises entre l’année 1990 et le 1er mars 2019. Pour notre propos, nous avons retenu des études si elles satisfaisaient à nos critères d’inclusion et si elles faisaient état de stratégies de traitement destinées à la resténose carotidienne et sous-tendant la pose d’endoprothèses. Nous avons ensuite extrait de ces études des données et les avons résumées. Un total de 25 études transversales a été inclus : 5 d’entre elles étaient de nature comparative ; 16 portaient sur l’angioplastie répétée ; et 4 portaient sur l'endartériectomie carotidienne. Notre étude a résumé les données actuelles disponibles et a montré, en nous fondant sur ces études précédentes, qu’il était possible atténuer de manière efficace la resténose carotidienne en améliorant de manière notable la technique angiographique de la sténose et en diminuant les valeurs maximales de tension systolique. En parallèle, on a noté que l'endartériectomie carotidienne était le traitement procurant les meilleurs résultats à long terme en ce qui concerne la resténose tandis que l’angioplastie percutanée transluminale au moyen de ballonnets actifs comportait toujours un certain taux de resténose variant entre 33 et 83 %. Plus encore, il convient de préciser que l’angioplastie percutanée transluminale avec ou sans ballonnets actifs entraînait moins de complications en comparaison avec l'endartériectomie carotidienne. Enfin, nous avons analysé les facteurs de risque pouvant affecter le pronostic à long terme des patients atteints de resténose carotidienne. Les mesures thérapeutiques destinées à la resténose carotidienne comportaient toutes leurs propres caractéristiques, l'endartériectomie carotidienne étant la plus efficace alors que l’angioplastie percutanée transluminale avec ou sans ballonnets actifs entraînait moins de complications. Chose certaine, des études cliniques comparatives de plus grande envergure demeurent nécessaires afin de déterminer quelles sont les meilleures stratégies.

Copyright

Corresponding author

Correspondence to: Shuo Wang, Department of Neurology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Neuroscience Institute, No. 106 Zhongshan Er Road, Guangzhou 510080, China. Email: wangshuo_gdgh@126.com

References

Hide All
1.Lesperance, J, Bourassa, MG, Schwartz, L, et al. Definition and measurement of restenosis after successful coronary angioplasty: implications for clinical trials. Am Heart J. 1993;125:1394–408.
2.Forte, A, Rinaldi, B, Berrino, L, Rossi, F, Galderisi, U, Cipollaro, M. Novel potential targets for prevention of arterial restenosis: insights from the pre-clinical research. Clin Sci (Lond). 2014;127:615–34.
3.Levy, EI, Hanel, RA, Lau, T, et al. Frequency and management of recurrent stenosis after carotid artery stent implantation. J Neurosurg. 2005;102:2937.
4.Ca, RSC. Carotid revascularization using endarterectomy or stenting systems (CaRESS) phase I clinical trial: 1-year results. J Vasc Surg. 2005;42:213–19.
5.Massop, D, Dave, R, Metzger, C, et al. Stenting and angioplasty with protection in patients at high-risk for endarterectomy: SAPPHIRE Worldwide Registry first 2,001 patients. Catheter Cardiovasc Interv. 2009;73:129–36.
6.Christiaans, MH, Ernst, JM, Suttorp, MJ, et al. Restenosis after carotid angioplasty and stenting: a follow-up study with duplex ultrasonography. Eur J Vasc Endovasc Surg. 2003;26:141–4.
7.de Borst, GJ, Ackerstaff, RG, de Vries, JP, et al. Carotid angioplasty and stenting for postendarterectomy stenosis: long-term follow-up. J Vasc Surg. 2007;45:118–23.
8.Lal, BK, Beach, KW, Roubin, GS, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11:755–63.
9.van Haaften, AC, Bots, ML, Moll, FL, de Borst, GJ. Therapeutic options for carotid in-stent restenosis: review of the literature. J Vasc Interv Radiol. 2010;21:1471–77.
10.Sangiorgi, G, Romagnoli, E, Biondi-Zoccai, G. Commentary: drug-eluting balloons for carotid in-stent restenosis: can this technology deliver the goods? J Endovasc Ther. 2012;19:743–48.
11.Zeller, T, Rastan, A, Macharzina, R, et al. Drug-coated balloons vs. drug-eluting stents for treatment of long femoropopliteal lesions. J Endovasc Ther. 2014;21:359–68.
12.Siontis, GC, Stefanini, GG, Mavridis, D, et al. Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis. Lancet. 2015;386:655–64.
13.Morr, S, Lin, N, Siddiqui, AH. Carotid artery stenting: current and emerging options. Med Devices (Auckl). 2014;7:343–55.
14.Zhou, W, Lin, PH, Bush, RL, et al. Management of in-sent restenosis after carotid artery stenting in high-risk patients. J Vasc Surg. 2006;43:305–12.
15.Chakhtoura, EY, Hobson, RW, 2nd, Goldstein, J, et al. In-stent restenosis after carotid angioplasty-stenting: incidence and management. J Vasc Surg. 2001;33:220–25.
16.Lal, BK, Hobson, RW, 2nd, Goldstein, J, et al. In-stent recurrent stenosis after carotid artery stenting: life table analysis and clinical relevance. J Vasc Surg. 2003;38:1162–68.
17.Lanzino, G, Mericle, RA, Lopes, DK, Wakhloo, AK, Guterman, LR, Hopkins, LN. Percutaneous transluminal angioplasty and stent placement for recurrent carotid artery stenosis. J Neurosurg. 1999;90:688–94.
18.Radak, D, Tanaskovic, S, Sagic, D, et al. Carotid angioplasty and stenting is safe and effective for treatment of recurrent stenosis after eversion endarterectomy. J Vasc Surg. 2014;60:645–51.
19.Raithel, D. Complications of carotid artery stenting. J Cardiovasc Surg (Torino). 2005;46:261–65.
20.Willfort-Ehringer, A, Ahmadi, R, Gschwandtner, ME, Haumer, M, Lang, W, Minar, E. Single-center experience with carotid stent restenosis. J Endovasc Ther. 2002;9:299307.
21.Koebbe, CJ, Liebman, K, Veznedaroglu, E, Rosenwasser, R. Carotid artery angioplasty and stent placement for recurrent stenosis. Neurosurg Focus. 2005;18:e7.
22.Gandini, R, Del Giudice, C, Da Ros, V, et al. Long-term results of drug-eluting balloon angioplasty for treatment of refractory recurrent carotid in-stent restenosis. J Endovasc Ther. 2014;21:671–77.
23.Montorsi, P, Galli, S, Ravagnani, PM, et al. Drug-eluting balloon for treatment of in-stent restenosis after carotid artery stenting: preliminary report. J Endovasc Ther. 2012;19:734–42.
24.Piccoli, G, Biondi-Zoccai, G, Gavrilovic, V, et al. Drug-coated balloon dilation before carotid artery stenting of post-carotid endarterectomy restenosis. J Endovasc Ther. 2015;22:212–16.
25.Pohlmann, C, Holtje, J, Zeile, M, Bonk, F, Urban, PP, Bruning, R. Recurrent stenosis following carotid artery stenting treated with a drug-eluting balloon: a single-center retrospective analysis. Neuroradiology. 2018;60:8187.
26.Tekieli, L, Pieniazek, P, Musialek, P, et al. Zotarolimus-eluting stent for the treatment of recurrent, severe carotid artery in-stent stenosis in the TARGET-CAS population. J Endovasc Ther. 2012;19:316–24.
27.Donas, KP, Eisenack, M, Torsello, G. Balloon angioplasty for in-stent stenosis after carotid artery stenting is associated with an increase in repeat interventions. J Endovasc Ther. 2011;18:720–25.
28.Heck, D. Results of cutting balloon angioplasty for carotid artery in-stent restenosis in six patients: description of the technique, long-term outcomes, and review of the literature. J Neurointerv Surg. 2009;1:4850.
29.Reimers, B, Tubler, T, de Donato, G, et al. Endovascular treatment of in-stent restenosis after carotid artery stenting: immediate and midterm results. J Endovasc Ther. 2006;13:429–35.
30.Setacci, F, Sirignano, P, de Donato, G, et al. Carotid highly-calcified de novo stenosis and cutting-balloon angioplasty: a tool to prevent haemodynamic depression? J Cardiovasc Surg (Torino). 2009;50:357–64.
31.Aburahma, AF, Bates, MC, Stone, PA, Wulu, JT. Comparative study of operative treatment and percutaneous transluminal angioplasty/stenting for recurrent carotid disease. J Vasc Surg. 2001;34:831–38.
32.Chung, J, Valentine, W, Sharath, SE, et al. Percutaneous intervention for carotid in-stent restenosis does not improve outcomes compared with nonoperative management. J Vasc Surg. 2016;64:1286–94.
33.Setacci, C, de Donato, G, Setacci, F, et al. In-stent restenosis after carotid angioplasty and stenting: a challenge for the vascular surgeon. Eur J Vasc Endovasc Surg. 2005;29:601–07.
34.de Borst, GJ, Ackerstaff, RG, Mauser, HW, Moll, FL. Operative management of carotid artery in-stent restenosis: first experiences and duplex follow-up. Eur J Vasc Endovasc Surg. 2003;26:137–40.
35.Marcucci, G, Accrocca, F, Giordano, A, Antonelli, R, Gabrielli, R, Siani, A. Results of surgical repair of carotid in-stent restenosis. J Cardiovasc Surg (Torino). 2012;53:707–14.
36.Reichmann, BL, van Laanen, JH, de Vries, JP, et al. Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting. J Vasc Surg. 2011;54:87–92.
37.Yu, LB, Yan, W, Zhang, Q, et al. Carotid endarterectomy for treatment of carotid in-stent restenosis: long-term follow-up results and surgery experiences from one single centre. Stroke Vasc Neurol. 2017;2:140–46.
38.Pourier, VE, de Borst, GJ. Technical options for treatment of in-stent restenosis after carotid artery stenting. J Vasc Surg. 2016;64:1486–96.
39.Wholey, MH, Wholey, M, Mathias, K, et al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv. 2000;50:160–67.
40.de Borst, GJ, Meijer, R, Lo, RH, Vosmeer, HW, Ackerstaff, RG, Moll, FL. Effect of carotid angioplasty and stenting on duplex velocity measurements in a porcine model. J Endovasc Ther. 2008;15:672–79.
41.Lal, BK, Kaperonis, EA, Cuadra, S, Kapadia, I, Hobson, RW, 2nd. Patterns of in-stent restenosis after carotid artery stenting: classification and implications for long-term outcome. J Vasc Surg. 2007;46:833–40.
42.Pierce, DS, Rosero, EB, Modrall, JG, et al. Open-cell versus closed-cell stent design differences in blood flow velocities after carotid stenting. J Vasc Surg. 2009;49:602–06; discussion 606.
43.Zahn, R, Ischinger, T, Zeymer, U, et al. Carotid artery interventions for restenosis after prior stenting: is it different from interventions of de novo lesions? Results from the carotid artery stent (CAS) – registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK). Clin Res Cardiol. 2010;99:809–15.
44.Jost, D, Unmuth, SJ, Meissner, H, Henn-Beilharz, A, Henkes, H, Hupp, T. Surgical treatment of carotid in-stent-restenosis: novel strategy and current management. Thorac Cardiovasc Surg. 2012;60:517–24.
45.Ederle, J, Bonati, LH, Dobson, J, et al. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial. Lancet Neurol. 2009;8:898907.
46.Ecker, RD, Pichelmann, MA, Meissner, I, Meyer, FB. Durability of carotid endarterectomy. Stroke. 2003;34:2941–44.
47.Marzullo, R, Aprile, A, Clementi, F, Stella, P, Modena, MG, Sangiorgi, GM. Paclitaxel eluting balloon: from bench to bedside. Minerva Cardioangiol. 2009;57:597609.
48.Weintraub, WS. The pathophysiology and burden of restenosis. Am J Cardiol. 2007;100:3K9K.

Keywords

A Review on the Comparison of Different Treatments for Carotid In-Stent Restenosis

  • Chizhong He (a1), Shuo Wang (a1), Xiaohong Zhou (a1) and Zhexian Yang (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed