Pohlmann C, Höltje J, Zeile M, Bonk F, Urban P P, Brüning R
Abteilung für Neurologie, Asklepios Klinik Barmbek, 22291, Hamburg, Germany.
Radiologie und Neuroradiologie, Asklepios Klinik Wandsbek, 22043, Hamburg, Germany.
Neuroradiology. 2018 Jan;60(1):81-87. doi: 10.1007/s00234-017-1935-7. Epub 2017 Oct 20.
Early in-stent restenosis after stent-protected angioplasty of the carotid artery (SPAC) is an infrequent, but potentially harmful condition for patients with carotid artery disease.
In our retrospective single-center analysis of 176 patients with carotid artery stenting between 2009 and 2015, using duplex ultrasound, we detected 9 patients with high-grade carotid artery in-stent restenosis. All restenosis patients were treated with a drug-eluting balloon (DEB) to prevent recurrent neointimal hyperplasia. One patient had bilateral carotid artery disease with bilateral in-stent restenosis, and 1 patient needed repeated DEB treatment 19 months after the first DEB intervention, so 11 DEB procedures, in total, were performed.
The median time-interval between primary carotid artery stenting and first DEB-treatment was 9 months. In 3 of the 11 interventions, the DEB treatment was assisted by an additional stent. One repeat DEB treatment was necessary, and three DEB treatments were followed by a secondary stent. No peri-interventional complications (TIA, stroke, or death) were observed during or after DEB intervention. Therefore, in the entire group, the 1y event-free survival (EFS) was 100%, and the 2y/3y/5y EFS was 83%.
DEB intervention seems to be an effective and safe treatment for patients with high-grade in-stent restenosis after SPAC.
颈动脉支架保护血管成形术（SPAC）后早期支架内再狭窄虽不常见，但对颈动脉疾病患者可能有害。
在我们对2009年至2015年间176例行颈动脉支架置入术患者的回顾性单中心分析中，通过双功超声检测到9例颈动脉支架内高度再狭窄患者。所有再狭窄患者均接受药物洗脱球囊（DEB）治疗以预防复发性内膜增生。1例患者患有双侧颈动脉疾病且双侧支架内再狭窄，1例患者在首次DEB干预后19个月需要重复DEB治疗，因此共进行了11次DEB手术。
初次颈动脉支架置入术与首次DEB治疗之间的中位时间间隔为9个月。在11次干预中的3次中，DEB治疗由额外的支架辅助。需要1次重复DEB治疗，3次DEB治疗后植入了二级支架。在DEB干预期间或之后未观察到围手术期并发症（短暂性脑缺血发作、中风或死亡）。因此，在整个组中，1年无事件生存率（EFS）为100%，2年/3年/5年EFS为83%。
DEB干预似乎是SPAC后支架内高度再狭窄患者的一种有效且安全的治疗方法。
