Technical options for treatment of in-stent restenosis after carotid artery stenting

The available evidence for ISR treatment is still limited owing to methodologic heterogeneity; therefore, no recommendation on the optimal intervention can be provided. Although PTA is the common treatment for ISR, recurrent ISR seems to limit the durability, leading to recurrent interventions and cost implications. A uniform definition for ISR is needed with a standardized workup to compare the treatment options based on individual patient data analysis. Drug-eluting techniques are emerging and may become the preferred treatment option, but long-term follow-up is needed to evaluate their efficacy. Further study and understanding of the effect of drug-eluting technologies on the brain and neurologic function is warranted.