Carotid in-stent restenosis and re-restenosis treated with drug-eluting balloon dilation - case report and literature review.

Abstract

According to relevant multicenter studies, significant in-stent stenosis develops in 5-6% of cases after internal carotid artery stenting. We present the risks, pathomechanism, diagnostics and treatment options of in-stent stenosis, the evidence, and the discrepancy between conservative and endovascular treatment. If the in-stent stenosis reaches a significant level, repeated endovascular treatment may be considered. The results of drug-eluting balloon dilation are better than balloon dilation. We present the case of a 72-year-old female patient. In an asymptomatic state, 80% stenosis of both internal carotid arteries was confirmed. Both sides were stented without complications. The patient did not have drug resistance, and the patient's compliance was very good. After 4 months, the patient was asymptomatic, and significant bilateral in-stent restenosis was confirmed. We performed drug-eluting balloon dilation in two sessions. In 3 months, we confirmed 85% in-stent restenosis again on the left side, due to which we performed repeated drug-eluting balloon dilation. The patient was asymptomatic and complaintfree. According to the last controls, there is currently no stenosis within the stents. Restenosis in the carotid stent can be effectively managed using drug-eluting balloon dilation, ensuring a high degree of safety. Our case, when a restenosis develops within a short time after drug-eluting ballon dilation, is very rare.