In Reply to: Case 0498_03 --Rapid intimal hyperplasia in a covered carotid stent posted by Editor on March 31, 1998 at 14:53:16:
Yikes.
1. Should this lesion be treated and how? Depends on how much he needs that carotid - what about a test occlusion if the narrowing progresses (hope Scott is right about possibility of regression). Time for the surgeon I think (CC/IC bypass?)
2. If you elect not to treat when would you follow the patient and how? Duplex often (like 6 weekly)
3. What is the likelihood of stroke in this patient? Embolic stroke is preumably lower risk so depends on test occlusion.
4. In retrospect, was it a mistake to put in this covered stent? probably as covered stents seem to have problems in vesssels of this diameter (such as the Corvita iliac stentgraft study) - Experience in carotids and elsewhere suggests that bare stents should be adequate (see discussion when this case first posted) until experience of covered stents in less critical vessels has shown these are significantly less likely to lead to intimal hyperplasia or thrombosis
5. Can we expect less intimal hyperplasia in covered stents compared to bare stents? We should but evidence in clinical studies (reported and unreported) is not encouraging, I would only use them where a surgical bail out is easier and the hazards of occlusion/stenosis less.