Drug-eluting balloon angioplasty shows excellent results for refractory recurrent carotid in-stent restenosis

499

Restenosis, the recurrence of narrowing of the arteries after stenting, is a common risk of this endovascular treatment. There are no well-defined guidelines to treat restenosis, but recent studies have shown excellent results with drug-eluting balloon angioplasty in coronary and femoral artery stents. However, few studies have focused on the carotid arteries, which take blood to the neck and head.

A long-term follow-up study reports on the safety and success of drug-eluting balloon angioplasty in treating patients with carotid in-stent restenosis that has proven refractory to treatment with balloon angioplasty and/or redo stenting. The results of this study are published in the current issue of the Journal of Endovascular Therapy. The researchers followed nine patients with significant (more than 80%) recurrent restenosis who underwent drug-eluting balloon angioplasty. In this procedure, a drug-eluting balloon is inflated for 60 seconds and delivers the drug paclitaxel, an inhibitor of the exuberant healing process after angioplasty that leads to restenosis.


The angioplasty was successful in all 9 patients, with stenosis decreasing from 87% to 6%. These patients had clinical and ultrasound follow-up every three months during the first 24 months after the procedure, then were followed every six months. By approximately 36 months after the drug-eluting balloon angioplasty, only three patients were found to have recurrent in-stent restenosis at 18, 25, and 32 months, respectively, after the initial angioplasty, a far longer interval without restenosis than earlier treatments provided.


These three patients underwent another drug-eluting balloon angioplasty procedure and did not experience restenosis at up to14 months after the second procedure. These results show the potential for the drug-eluting balloon treatment to improve outcomes for patients with early recurrent carotid in-stent restenosis. 


In a related commentary article, the authors discuss lessons learned through this research. Their primary advice is not to wait, but to choose drug-eluting balloon angioplasty for treatment after the first failure of conventional endovascular intervention. They also urge practitioners to keep up to date on the ongoing trials of this treatment.