Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
J Endovasc Ther. 2012 Dec;19(6):734-42. doi: 10.1583/JEVT-12-4042R.1.
To evaluate the safety and efficacy of drug-eluting balloons (DEB) for the treatment of in-stent restenosis (ISR) after carotid artery stenting (CAS).
Among 830 consecutive patients undergoing CAS between November 2001 and June 2012, significant ISR (>80% stenosis) occurred in 10 (1.2%) asymptomatic patients. Angioplasty with DEB treatment was performed in 7 patients (6 internal and 1 common carotid arteries) at a mean of 20.9 ± 19.4 months (median 12.1) after CAS. Intravascular ultrasound (IVUS)-guided predilation with distal cerebral protection was carried out with a cutting balloon followed by inflation of a DEB with a 1:1 stent-to-balloon size ratio.
Technical/procedural success was achieved in all cases. Angiographic stenosis decreased from 83%± 5% to 18%± 6%. At IVUS evaluation, minimal lumen area increased from 3.19 ± 1.73 to 12.78 ± 1.97 mm(2) (p=0.0001), stent area was unchanged (from 17.36 ± 4.36 to 17.52 ± 4.34 mm(2), p=0.70), and the restenosis area decreased from 13.58 ± 5.27 to 4.71 ± 3.06 mm(2) (p=0.0005). At a mean follow-up of 13.7 ± 1.5 months (median 13.7), 1 patient had a minor stroke ipsilateral to the ISR vessel 2 months after DEB treatment; the stent was widely patent on duplex ultrasound and angiographic images. Overall, the average PSV decreased from 4.0 ± 1.0 to 0.9 ± 0.1 m/s (p=0.0001). At 6 and 12 months, PSVs after DEB treatment were significantly lower compared to those assessed at comparable intervals after CAS.
The use of DEBs to treat ISR after CAS shows promising acute and midterm results.
评估药物洗脱球囊（DEB）治疗颈动脉支架置入（CAS）后支架内再狭窄（ISR）的安全性和有效性。
在 2001 年 11 月至 2012 年 6 月期间连续进行的 830 例 CAS 患者中，10 例（1.2%）无症状患者发生明显的 ISR（>80%狭窄）。在 CAS 后平均 20.9±19.4 个月（中位数 12.1）对 7 例患者（6 例颈内动脉和 1 例颈总动脉）行 DEB 治疗球囊扩张术。采用切割球囊进行血管内超声（IVUS）引导的预扩张，并采用 1:1 支架与球囊比进行 DEB 扩张。
所有病例均获得技术/程序成功。血管造影狭窄程度从 83%±5%降至 18%±6%。在 IVUS 评估中，最小管腔面积从 3.19±1.73 增至 12.78±1.97 mm²（p=0.0001），支架面积无变化（从 17.36±4.36 增至 17.52±4.34 mm²，p=0.70），再狭窄面积从 13.58±5.27 降至 4.71±3.06 mm²（p=0.0005）。在平均 13.7±1.5 个月（中位数 13.7）的随访中，1 例患者在 DEB 治疗后 2 个月出现 ISR 血管同侧的小中风；支架在双功能超声和血管造影图像上均保持通畅。总体而言，平均 PSV 从 4.0±1.0 降至 0.9±0.1 m/s（p=0.0001）。在 DEB 治疗后 6 个月和 12 个月，PSV 值明显低于 CAS 后可比间隔的 PSV 值。
DEB 治疗 CAS 后 ISR 的应用显示出有前途的急性和中期结果。
