AUTHOR=Huang Hao , Wu Lingshan , Guo Yinping , Zhang Yi , Zhao Jing , Yu Zhiyuan , Luo Xiang 

TITLE=Treatment of the Carotid In-stent Restenosis: A Systematic Review

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.748304

DOI=10.3389/fneur.2021.748304

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> In-stent restenosis (ISR) after carotid artery stent (CAS) is not uncommon. We aimed to evaluate therapeutic options for ISR after CAS.</p><p><bold>Methods:</bold> We searched PubMed and EMBASE until November 2, 2020 for studies including the treatment for ISR after CAS.</p><p><bold>Results:</bold> 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 &amp; 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%, <italic>P</italic> = 0.046). Furthermore, the rate of long-term stroke &amp; TIA in PTA was 5.7%, significantly higher than rCAS (1.8%, <italic>P</italic> = 0.036). PTA (27.8%) was also associated with a significantly higher recurrent restenosis rate than rCAS (8.2%, <italic>P</italic> = 0.002) and CEA (1.6%, <italic>P</italic> &lt; 0.001). The long-term stroke &amp; TIA and recurrent restenosis rates showed no significant difference between rCAS and CEA.</p><p><bold>Conclusions:</bold> 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 &amp; TIA and recurrent restenosis.</p>