ArticleCureus2026
Carotid Endarterectomy With Stent Explantation for In-Stent Restenosis in Two Patients and Review of the Literature.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Carotid artery stenting (CAS) is a well-established alternative to carotid endarterectomy (CEA) for the treatment of carotid artery stenosis, particularly in patients at high surgical risk. However, in-stent restenosis (ISR) remains a notable long-term complication, occurring in up to 20% of patients within five years. The optimal management strategy for ISR remains unclear, as endovascular reintervention carries a significant risk of recurrence, and evidence supporting surgical explantation is limited. We present two patients who developed severe carotid ISR and were successfully treated with CEA and complete stent explantation followed by bovine pericardial patch angioplasty. The first patient, an 84-year-old woman with bilateral carotid disease and a history of left carotid stenting, developed 90% restenosis at surveillance and underwent staged bilateral carotid revascularization with durable patency at three-year follow-up. The second patient, a 70-year-old man, presented with acute visual loss and imaging demonstrating near-occlusive thrombosis within a previously placed carotid stent. He underwent urgent surgical stent removal and patch angioplasty, achieving full recovery and maintaining patency at one year. Neither patient experienced perioperative neurological or cardiovascular complications. These cases highlight the feasibility and safety of surgical stent explantation in the management of carotid ISR. Compared with repeat endovascular interventions, surgical removal directly addresses the underlying mechanical and neointimal causes of restenosis and may provide superior long-term durability in appropriately selected patients. CEA with stent explantation represents an effective treatment option for ISR, particularly when endovascular options are limited by calcification, thrombus, or mechanical failure. Larger prospective studies are needed to establish patient selection criteria and optimize management strategies for this challenging clinical scenario.
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