In-Stent Restenosis after Carotid Artery Stent Placement Comparing Maximum Plaque Predilation and Postdilation

Purpose: To compare the incidence of in-stent restenosis (ISR) and ipsilateral neurologic symptoms in patients treated with maximum plaque dilation before stent deployment (max-pre-D) and stent placement followed by angioplasty (post-D) technical variants of carotid artery stent placement at midterm follow-up. Materials and Methods: This was a single-center, real-world, retrospective comparative study of 307 patients treated in a single vascular surgery unit between 2014 and 2018. The follow-up protocol consisted of Doppler US performed at 1, 6, and 12 months and annually thereafter. The primary outcome was to compare the incidence of ISR ≥70% in patients treated with post-D and max-pre-D. Secondary outcomes included between-group comparison of the following: (a) symptomatic ISR, (b) reinterventions, and (c) ipsilateral neurologic events. Results: A total of 270 patients (121 in the max-pre-D group and 149 in the post-D group) fulfilling the inclusion criteria were included in the statistical analysis. Mean follow-up was 30.5 months (SD ± 25.6). The ISR rate was 4.1% (n = 5) in the max-pre-D group and 2.7% (n = 4) in the post-D group, with no significant difference in the survival analysis (log-rank P = .664). Symptomatic ISR and retreatment occurred in 3 patients (33.3% of the total ISR for each outcome). Twenty-one ipsilateral neurologic events occurred, 7 in the max-pre-D group (5.8%) and 14 in the post-D group (9.9%), with no statistically significant difference in survival analysis (log-rank P = .315). Conclusions: ISR and major neurologic events did not differ significantly between the max-pre-D and post-D groups. Max-pre-D seemed to be as effective as post-D technique in midterm follow-up.