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  • Instent Restenosis After Carotid Stenting: Treatment Using an Off-Label Cardiac Scoring Balloon

    Final Number:

    Grant C. Sorkin MD; Travis Michael Dumont MD; Jorge Luis Eller MD; Maxim Mokin; Kenneth V. Snyder MD, PhD; Adnan Hussain Siddiqui MD, PhD; L. Nelson Hopkins MD; Elad I. Levy MD, FACS, FAHA, FAANS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: The rate of instent restenosis after Carotid Artery Stenting (CAS) varies according to literature source and degree of restenosis, ranging from 1–21% over 12–18 months. Treatment of instent restenosis due to circumferential or calcified lesions can be difficult and refractory to angioplasty.

    Methods: We describe the first off-label use of a cardiac scoring balloon used in two patients for instent carotid restenosis refractory to angioplasty with conventional balloons. The AngioSculpt percutaneous transluminal coronary angioplasty (PTCA) scoring balloon catheters (AngioScore, Fremont CA, USA) are unique angioplasty balloons that have 3 rectangular scoring wires that spiral around the longitudinal axis of a semicompliant balloon. Compared to cutting balloons, AngioSculpt balloons are lower profile, more flexible given the spiral arrangement of scoring wires, and create more scoring marks per millimeter of plaque. This allows the ability to achieve higher nominal and burst pressures (as high as 20 atmospheres) suited for calcified and circumferential plaque.

    Results: Two patients with a history of carotid artery stenting 6 and 8 years ago, presented with symptomatic carotid instent restenosis caused by circumferential and calcified lesions, respectively (Figures 1,3,4). Angioplasty with conventional compliant and noncompliant balloons was unsuccessful. An AngioSculpt percutaneous transluminal coronary angioplasty (PTCA) scoring balloon catheter was successful in achieving vessel recanalization despite the refractory nature of these lesions (Figures 2,5). No further conventional balloons or use of cutting balloons were required.

    Conclusions: The AngioSculpt PTCA scoring balloon catheter can be a useful option for treatment of refractory calcified or circumferential carotid instent restenosis.

    Patient Care: We hope to demonstate another tool in the armamentarium in the treatment of complex carotid instent restenosis.

    Learning Objectives: By the conclusion of this session, participants should be familiar with the AngioSculpt PTCA scoring balloon catheter as option for the treatment of carotid instent restenosis.

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