Carotid Endarterectomy with Stent Removal in Management of In-stent Restenosis: A Safe, Feasible, and Effective Technique

IntroductionThe optimal treatment of in-stent restenosis (ISR) is not determined. We describe the efficacy of carotid endarterectomy (CEA) with stent removal in the management of symptomatic ISR.MethodsA 72-year-old man presented with recurrent right limb weakness 8 months after carotid artery stenting. Digital substraction angiography showed severe ISR (almost 99%). CEA with stent removal was performed.ResultsA total of 41 cases was reviewed: periarterial inflammation was shown in 10.3% of patients; 92.9% had clear intima-media plane; and 85.4% had a good outcome. All patients remained stable at follow-up.DiscussionCEA with stent removal appears to be a safe, feasible, effective, and durable therapeutic option.