Long-term Results of Drug-Eluting Balloon Angioplasty for Treatment of Refractory Recurrent Carotid In-Stent Restenosis

Purpose: To evaluate the potential role, safety, and efficacy of paclitaxel-eluting balloon angioplasty for treatment of recurrent carotid in-stent restenosis (ISR). Methods: Among 856 consecutive patients who underwent carotid artery stenting from May 2002 to January 2008, 41 patients had a significant ISR (>80% stenos's). Of these, 9 patients (7 women; mean age 78.1 +/- 5.6 years) had recurrent ISR despite multiple endovascular treatments (3.4 +/- 0.9 interventions) within a short period of time (2-5 months). These patients were treated with drug-eluting balloon (DEB) angioplasty for neointimal hyperplasia. Imaging (ultrasound or computed tomographic angiography) was performed at 1, 3, and 6 months and yearly thereafter. Results: Technical success was obtained in 100% of cases, with angiographic stenosis decreasing from 87% +/- 4% to 6% +/- 4% post treatment. Peak systolic velocity decreased significantly from 4.7 +/- 1.5 m/s to 0.6 +/- 0.3 m/s after the procedure. Over a mean follow-up of 36.6 +/- 2.7 months, ultrasound imaging indicated recurrent ISR in only 3 patients at 18, 25, and 32 months after DEB angioplasty, respectively. The target vessel revascularization rate was 33.3% at 36 months. No neurological or myocardial events were recorded during follow-up. One patient died at 3 months. Conclusion: DEB may have a potential role improving outcomes of those patients treated for early recurrent carotid ISR.