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OBJECTIVES:
Carotid artery stent (CAS) is subject to restenosis that may require explantation. The purpose of this study is to describe the indication, treatment and outcomes of patients undergoing CAS explantation.
METHODS:
A retrospective review of all patients undergoing explantation of CAS placed at the carotid bifurcation for internal carotid artery occlusive disease at three academic medical centers (2003-2013). Indications for explantation, prior treatments, mode of treatment, and outcomes were reviewed.
RESULTS:
Over a 10 year interval, 8 patients underwent CAS explantation (mean age 69 +/-9.9yrs, 63% male). Stent placement was for prior neck surgery (2) and high lesion (3). Only 2 patients underwent angioplasty (1) or restenting (1) prior to explantation. Four patients presented with minor stroke and five had >70% in-stent restenosis. Mode of repair was endarterectomy with patch angioplasty in five and bypass with vein in three patients. Repair extended to C2 in 5 and C1 in one patient. Shunts were used in half of the patients. There were no post-operative strokes or cranial nerve injury. Postoperative complications included blood pressure lability requiring treatment (3) and pneumonia (1). Median follow-up was 16 months (range 5-107). One patient had >80% restenosis after bypass (136 days post-op) treated with angioplasty. Two late disabling strokes occurred (14 and 19 months) after patch repair, one was a known ipsilateral event from the prior repair site.
CONCLUSIONS:
CAS explant in an uncommonly required procedure involving CAS removal with patch angioplasty or bypass. Although small, our series demonstrates safety and feasibility in patients deemed to have been anatomic high risk. However, restenosis and late stroke remain concerns despite explantation making patient selection critical.