To evaluate the feasibility, safety and long-term efficacy of carotid endarterectomy with patch angioplasty in the treatment of in-stent restenosis (ISR).

The clinical data of 8 cases with ISR treated with carotid endarterectomy with patch angioplasty from October 2018 to March 2022 in the department of Neurosurgery of the first affiliated hospital of China Medical University were retrospectively analyzed. They were 52-73 years old, with a median age of 64.0 (IQR 56.0, 69.0) years. The interval between carotid endarterectomy with patch angioplasty and carotid artery stenting (CAS) ranged from 4 days to 124 months, with a median interval of 11.5 (IQR 4.0, 18.5) months. Among them, the case with an interval of 4 days was surgical retrieval of a filter protection device in CAS with two open-cell stents. All patients were diagnosed by digital subtraction angiography and treated with carotid endarterectomy with patch angioplasty. One of the patients presented with symptomatic moderate restenosis 22 months after ISR was treated by carotid endarterectomy with patch angioplasty in another hospital, and carotid artery patch angioplasty was performed in our hospital. Carotid ultrasound or computed tomography angiography was followed up at 1, 3, 6, 12 months and every year postoperatively.

All patients underwent carotid artery patch angioplasty successfully. Stents and atherosclerotic plaque were removed in 6 patients. Two stents and one filter protection device and atherosclerotic plaque were removed in another patient. Transcranial ultrasound doppler was applied in 7 patients (87.5%)，and carotid shunt tubes were used in 5 patients (62.5%). The success rate of surgical technique is 100%. No intracranial hemorrhage, new-onset cerebral infarction, myocardial ischemia, and cerebral tissue hyperperfusion occurred after the operation. There was one case of hypoglossal nerve injury and one of vagus nerve injury, who both recovered completely at 3-month follow-up. On the day of the operation, one patient had a transient attack of contralateral upper limb weakness. Postoperative follow-up was 7-47 months, with a median follow-up time of 29.5 (IQR 17.5, 42.0) months. No moderate or severe carotid artery restenosis occurred during follow-up, and all patients returned to normal life.

carotid endarterectomy with patch angioplasty can safely and effectively treat ISR and the postoperative long-term curative effect was satisfied