Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.
Department of Surgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary.
Clin Neuroradiol. 2024 Mar;34(1):147-154. doi: 10.1007/s00062-023-01343-6. Epub 2023 Sep 7.
In-stent restenosis (ISR) following internal carotid artery (ICA) stenting is relatively common with an estimated incidence of 5%. Treatment options include repeat angioplasty with conventional or drug-eluting balloons (DEB), repeat stent angioplasty and surgical intervention. Application of DEB in ISR of the coronary and peripheral arteries is an established method; however, data on DEB treatment of ICA ISR are sparse. In this work, results from a retrospective cohort of 45 patients harboring 46 ICA ISR lesions treated with DEB angioplasty are presented.
Clinical, procedural and imaging data from DEB angioplasty treatment of 46 high-grade ICA ISR lesions in 45 patients, performed between 2013 and 2021 were collected. A single type of DEB (Elutax, Aachen Resonance, Aachen, Germany) was used in all procedures. Imaging follow-up was performed by regular Doppler ultrasound (DUS), verified by computed tomography angiography (CTA) in cases suspicious for a recurrent ISR.
Technical success was 100%. Intraprocedural and postprocedural complications were not encountered. Clinical follow-up was obtained in all patients. Recurrent stroke in the affected territory was not encountered. A recurrent ISR following DEB treatment was confirmed by DUS and CTA in 4/46 (8.7%) of the lesions and were retreated with DEB. A third recurrent ISR occurred in a single case (2%) and following a second DEB retreatment there were no signs of a fourth recurrence after 36 months follow-up.
The use of DEB angioplasty is a safe and effective treatment of ICA ISR lesions, yielding significantly better results compared to other modalities. Randomized multicenter studies are warranted.
颈内动脉（ICA）支架置入后发生的支架内再狭窄（ISR）相对较为常见，估计发生率为 5%。治疗选择包括传统或药物洗脱球囊（DEB）重复血管成形术、重复支架血管成形术和手术干预。DEB 在冠状动脉和外周动脉的 ISR 中的应用是一种已确立的方法；然而，关于 DEB 治疗 ICA-ISR 的数据很少。在这项工作中，报告了 45 例 46 例 ICA-ISR 病变患者接受 DEB 血管成形术治疗的回顾性队列研究结果。
收集了 2013 年至 2021 年间对 45 例患者的 46 例 ICA 高度 ISR 病变进行 DEB 血管成形术治疗的临床、手术和影像学数据。所有手术均使用单一类型的 DEB（德国亚琛 Resonance 的 Elutax）。在怀疑发生复发性 ISR 的情况下，通过常规多普勒超声（DUS）进行影像学随访，并通过计算机断层血管造影（CTA）进行验证。
技术成功率为 100%。术中及术后均未发生并发症。所有患者均获得临床随访。未发生受累区域的复发性卒中。46 例病变中有 4 例（8.7%）通过 DUS 和 CTA 证实 DEB 治疗后发生复发性 ISR，并再次接受 DEB 治疗。1 例（2%）出现第三次复发性 ISR，第二次 DEB 再治疗后，36 个月随访时无第四次复发迹象。
DEB 血管成形术治疗 ICA-ISR 病变是一种安全有效的治疗方法，与其他方法相比，效果显著更好。需要进行随机多中心研究。
