Department of Vascular Surgery, University Medical Center Utrecht, G 04.129, PO Box 85500, 3508 GA Utrecht, The Netherlands.
J Vasc Interv Radiol. 2010 Oct;21(10):1471-7. doi: 10.1016/j.jvir.2010.06.010.
To critically evaluate published evidence on therapeutic options for in-stent restenosis (ISR) after carotid artery stent (CAS) placement, a systematic analysis of studies reporting interventions for ISR after CAS placement was conducted. In total 20 studies were found, describing 100 interventions after carotid ISR in 96 patients. The interventions most performed were repeat percutaneous transluminal angioplasty (PTA; n = 54), repeat CAS placement (n = 31), and carotid endarterectomy with stent removal (n = 9). No periprocedural complications were identified in any of the studies evaluated. Recurrent restenosis after intervention for ISR occurred in 12 of 84 cases (14%). All 12 patients received tertiary treatment. Two patients developed a third recurrence and eventually disabling stroke, one of whom died. In the other 10 interventions, no further follow-up was described. In conclusion, several treatment strategies for ISR after CAS placement have been reported, with acceptable short-term results. The quality of the currently available data is still limited by the variability of results and study designs. Therefore, no recommendation can be made for any specific therapy. This argues for better study design and more consistency of reporting standards.
为了批判性地评估颈动脉支架置入（CAS）后支架内再狭窄（ISR）治疗选择的已有证据，对报道 CAS 后 ISR 干预措施的研究进行了系统分析。共发现 20 项研究，描述了 96 例颈动脉 ISR 患者的 100 次干预。最常进行的干预措施是重复经皮腔内血管成形术（PTA；n=54）、重复 CAS 放置（n=31）和颈动脉内膜切除术联合支架取出（n=9）。在评估的所有研究中均未发现任何围手术期并发症。12 例 84 例 ISR 介入治疗后再次出现再狭窄（14%）。所有 12 例患者均接受了三级治疗。2 例患者发生第三次复发，最终导致致残性卒中，其中 1 例死亡。在另外 10 次干预中，未进一步描述随访情况。总之，已经报道了几种 CAS 后 ISR 的治疗策略，短期结果可接受。目前可用数据的质量仍然受到结果和研究设计的差异的限制。因此，不能对任何特定的治疗方法提出建议。这就需要更好的研究设计和更一致的报告标准。
