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OBJECTIVES:
Carotid Artery Stenting (CAS) is non-inferior to Carotid Endarterectomy (CEA) as a management of carotid artery stenosis. It is commonly performed for patients with recurrent carotid artery stenosis after previous intervention, external beam irradiation of the ipsilateral neck, lesions distal to the C2 vertebral body, and patients unfit for open surgery. The objective of this study is to review the incidence and management of re-stenosis after CAS.
METHODS:
A retrospective single-institution review was conducted for all patients >18 years of age who underwent CAS and presented again with carotid artery stenosis from 1/1/00 through 8/30/15. Variables recorded included repeat surgical interventions, comorbidities and mortality rates.
RESULTS:
Of the 192 CAS that were placed over the 15-year study period, 24 patients were identified with 27 episodes of re-stenosis. Of these patients, 13 were male and 11 female. One patient developed re-stenosis after CAS bilaterally. The average age at re-stenosis was 72.1+8.1 years. Co-morbidities expressed per procedure at the time of restenosis are shown in Table 1. Nine procedures were performed on symptomatic patients at the original time of CAS (9/26, 35%), while six procedures were performed on symptomatic patients at the time of restenosis 6/27 (22.2%). Twenty-three re-interventions were performed following the 27 episodes of restenosis (85.2%). Two patients required two separate re-intervention procedures after original CAS and one patient required three separate re-interventions. The types of re-intervention included CEA with stent removal (1 procedure), repeat CAS (18 procedures), angiogram without intervention (3 procedures), and balloon angioplasty without stenting (1 procedure). For this cohort, the median time to re-intervention was 21.1 months (range 1-117) and the median follow-up was 81.5 months (range 0-148). Five patients were lost to follow-up following their procedure and 8 patients died in the follow-up period. The median time from CAS to death was 95.0 months, the median time from re-intervention after CAS was 74.0 months.
CONCLUSIONS:
While re-stenosis after CAS is an infrequent event, it often requires secondary intervention for symptomatic and asymptomatic patients. This can largely be managed with repeat CAS.

Comorbidities at the time of restenosis (n= 27)

Current smoking status	3
Former smoking status	17
Never smoking status	5
Average smoking pack years	25
Coronary Artery Disease	19
Cerebrovascular Accident	5
Diabetes Mellitus	8
Hypertension	26
Hyperlipidemia	27
Average BMI (n=23)	27.5+4.2