Main Article Content
Carotid restenosis [MeSH]; endovascular treatment [MeSH]; carotid artery stenting [MeSH], carotid bypass [MeSH].
Background and aim: Restenosis after open carotid surgery (OCS) represents an issue that experts are very often facing nowadays, both after carotid endoarterectomy(CEA) and carotid bypass(CB). Yet, even if from one side carotid artery stenting (CAS) is currently recommended by most guidelines as treatment of choice for carotid restenosis after CEA, on the other side little is known regarding the best treatment of restenosis after CB. This clinical case report is aimed to empathize the endovascular treatment as an effective therapeutic option for restenosis after OCS. Methods: A 75-year-old woman with severe comorbidities was admitted to our Unit for left carotid bypass graft restenosis. One year earlier, the patient had been treated with left carotid bypass grafting in saphenous vein for infectious complications occurred after CEA for symptomatic left carotid stenosis. The patient underwent a carotid Duplex ultrasonography scan (DUS) which showed a hemodynamically significant left carotid venous graft stenosis with peak systolic velocity of 315 cm/sec; in order to assess the grade of the stenosis a computed tomography angiography confirmed the presence of a significant narrowing of left carotid graft. A carotid artery angiography was performed after 20days, reconfirming the presence of a significant left carotid graft stenosis and was successfully treated with 7x40mm self-expanding stent. Results: The patient had an uneventful post-procedural course and was discharged the day after. After six months, the patient underwent a carotid DUS in our outpatient clinic which confirmed the overall graft and stent patency. Conclusion: CAS represents a feasible therapeutic option for carotid restenosis in patients treated after CB. This clinical case demonstrates that CAS can be performed with acceptable risks and good early results
2) Setacci C, Argenteri A, Cremonesi A, et al. Linee Guida SICVE-Patologia carotidea. Italian J Vasc and Endovasc Surg 2015;22:13-24.
3) Naylor AR, Ricco JB, De Borst GJ, et al. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018;55:3-81.
4) Lauder C, Kelly A, Thompson MM, London NJM, Bell PRF, Naylor AR. Early and late outcome after carotid artery bypass grafting with saphenous vein. J Vasc Surg 2003;38:1025-30.
5) Illuminati G, Belmonte R, Schneider F, Pizzardi G, Calió FG, Ricco JB. Prosthetic bypass for restenosis after endarterectomy or stenting of the carotid artery. J Vasc Surg 2017;65:1664-72.
6) Naylor AR. Management of prosthetic patch infection after CEA. J Cardiovasc Surg. 2016;57:137-44
7) Lal BK. Recurrent carotid stenosis after CEA and CAS: diagnosis and management. Semin Vasc Surg 2007;20:259-66.
8) Midy D, Berard X, Becquemin JP, et al. Multicentric retrospective study of endovascular treatment for restenosis after open carotid surgery. Eur J Vasc Endovasc Surg 2011;42:742-50.
9) Archie JP Jr. Reoperations for carotid artery stenosis: role of primary and secondary reconstructions. J Vasc Surg 2001;33: 495-503.
10) Tu J, Wang S, Huo Z, Wu R, Yao C, Wang S. Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: systematic review and meta-analysis. Surgery 2015;157:1166-73
11) Camiade C, Maher A, Ricco JB, et al. Carotid bypass with polytetrafluoro-ethylene grafts: a study of 110 consecutive patients. J Vasc Surg 2003;38:1031-1038.
12) Fokkema M, Vrijenhoek JE, Den Ruijter HM, Groenwald RH, Schermerhorn ML, Bots ML. Stenting versus endarterectomy for restenosis following prior ipsilateral carotid endarterectomy: an individual patient data meta-analysis. Ann Surg 2015;261:598-604.
13) Beebe HG. Scientific evidence demonstrating the safety of carotid angioplasty and stenting: do we enough to draw conclusions yet? J Vasc Surg 1998;27:788-90.
14) Healy DA, Zierler RE, Nicholls SC, et al. Long-term follow-up and clinical outcome of carotid restenosis. J Vasc Surg 1989;10:662-8.
15) Ricco JB, Marchand C, Neau JP, Marchand E, Cau J, Febrer G. Prosthetic carotid bypass grafts for atherosclerotic lesions: a prospective study of 198 consecutive cases. Eur J Vasc Endovasc Surg 2009;37:272-8