Treatment of the Carotid In-stent Restenosis: A Systematic Review
Background and Purpose: In-stent restenosis (ISR) after carotid artery stent (CAS) is not uncommon. We aimed to evaluate therapeutic options for ISR after CAS.Methods: We searched PubMed and EMBASE until November 2, 2020 for studies including the treatment for ISR after CAS.Results: In total, 35 stu...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-10-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.748304/full |
| _version_ | 1818717358349352960 |
|---|---|
| author | Hao Huang Lingshan Wu Yinping Guo Yi Zhang Jing Zhao Zhiyuan Yu Xiang Luo |
| author_facet | Hao Huang Lingshan Wu Yinping Guo Yi Zhang Jing Zhao Zhiyuan Yu Xiang Luo |
| author_sort | Hao Huang |
| collection | DOAJ |
| description | Background and Purpose: In-stent restenosis (ISR) after carotid artery stent (CAS) is not uncommon. We aimed to evaluate therapeutic options for ISR after CAS.Methods: We searched PubMed and EMBASE until November 2, 2020 for studies including the treatment for ISR after CAS.Results: In total, 35 studies, covering 1,374 procedures in 1,359 patients, were included in this review. Most cases (66.3%) were treated with repeat CAS (rCAS), followed by percutaneous transluminal angioplasty (PTA) (17.5%), carotid endarterectomy (CEA) (14.3%), carotid artery bypass (1.5%), and external beam radiotherapy (0.4%). The rates of stroke & TIA within the postoperative period were similar in three groups (PTA 1.1%, rCAS 1.1%, CEA 1.5%). CEA (2.5%) was associated with a slightly higher rate of postoperative death than rCAS (0.7%, P = 0.046). Furthermore, the rate of long-term stroke & TIA in PTA was 5.7%, significantly higher than rCAS (1.8%, P = 0.036). PTA (27.8%) was also associated with a significantly higher recurrent restenosis rate than rCAS (8.2%, P = 0.002) and CEA (1.6%, P < 0.001). The long-term stroke & TIA and recurrent restenosis rates showed no significant difference between rCAS and CEA.Conclusions: rCAS is the most common treatment for ISR, with low postoperative risk and low long-term risk. CEA is an important alternative for rCAS. PTA may be less recommended due to the relatively high long-term risks of stroke & TIA and recurrent restenosis. |
| first_indexed | 2024-12-17T19:33:53Z |
| format | Article |
| id | doaj.art-5650a5fb7025487d830cc4193e62bb68 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-17T19:33:53Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-5650a5fb7025487d830cc4193e62bb682022-12-21T21:35:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-10-011210.3389/fneur.2021.748304748304Treatment of the Carotid In-stent Restenosis: A Systematic ReviewHao HuangLingshan WuYinping GuoYi ZhangJing ZhaoZhiyuan YuXiang LuoBackground and Purpose: In-stent restenosis (ISR) after carotid artery stent (CAS) is not uncommon. We aimed to evaluate therapeutic options for ISR after CAS.Methods: We searched PubMed and EMBASE until November 2, 2020 for studies including the treatment for ISR after CAS.Results: In total, 35 studies, covering 1,374 procedures in 1,359 patients, were included in this review. Most cases (66.3%) were treated with repeat CAS (rCAS), followed by percutaneous transluminal angioplasty (PTA) (17.5%), carotid endarterectomy (CEA) (14.3%), carotid artery bypass (1.5%), and external beam radiotherapy (0.4%). The rates of stroke & TIA within the postoperative period were similar in three groups (PTA 1.1%, rCAS 1.1%, CEA 1.5%). CEA (2.5%) was associated with a slightly higher rate of postoperative death than rCAS (0.7%, P = 0.046). Furthermore, the rate of long-term stroke & TIA in PTA was 5.7%, significantly higher than rCAS (1.8%, P = 0.036). PTA (27.8%) was also associated with a significantly higher recurrent restenosis rate than rCAS (8.2%, P = 0.002) and CEA (1.6%, P < 0.001). The long-term stroke & TIA and recurrent restenosis rates showed no significant difference between rCAS and CEA.Conclusions: rCAS is the most common treatment for ISR, with low postoperative risk and low long-term risk. CEA is an important alternative for rCAS. PTA may be less recommended due to the relatively high long-term risks of stroke & TIA and recurrent restenosis.https://www.frontiersin.org/articles/10.3389/fneur.2021.748304/fullin-stent restenosis (ISR)treatmentpercutaneous transluminal angioplasty (PTA)carotid endarterectomy (CEA)carotid artery stent (CAS) |
| spellingShingle | Hao Huang Lingshan Wu Yinping Guo Yi Zhang Jing Zhao Zhiyuan Yu Xiang Luo Treatment of the Carotid In-stent Restenosis: A Systematic Review Frontiers in Neurology in-stent restenosis (ISR) treatment percutaneous transluminal angioplasty (PTA) carotid endarterectomy (CEA) carotid artery stent (CAS) |
| title | Treatment of the Carotid In-stent Restenosis: A Systematic Review |
| title_full | Treatment of the Carotid In-stent Restenosis: A Systematic Review |
| title_fullStr | Treatment of the Carotid In-stent Restenosis: A Systematic Review |
| title_full_unstemmed | Treatment of the Carotid In-stent Restenosis: A Systematic Review |
| title_short | Treatment of the Carotid In-stent Restenosis: A Systematic Review |
| title_sort | treatment of the carotid in stent restenosis a systematic review |
| topic | in-stent restenosis (ISR) treatment percutaneous transluminal angioplasty (PTA) carotid endarterectomy (CEA) carotid artery stent (CAS) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.748304/full |
| work_keys_str_mv | AT haohuang treatmentofthecarotidinstentrestenosisasystematicreview AT lingshanwu treatmentofthecarotidinstentrestenosisasystematicreview AT yinpingguo treatmentofthecarotidinstentrestenosisasystematicreview AT yizhang treatmentofthecarotidinstentrestenosisasystematicreview AT jingzhao treatmentofthecarotidinstentrestenosisasystematicreview AT zhiyuanyu treatmentofthecarotidinstentrestenosisasystematicreview AT xiangluo treatmentofthecarotidinstentrestenosisasystematicreview |