Amongst others, the results from the SPACE study have encouraged those claiming that restenosis might be a relatively benign pathology [16] and [44]. On the other hand, especially long-term follow-up

data raise concern that patients with ISR could be suffering from a higher complication rate in comparison to patients without ISR [30]. Since CAS is often recommended the treatment of choice in younger patients (<70a) [3], [4], [5] and [9] it is of greatest interest to evaluate the complication rates of ISR in the long run. By now, the results regarding the incidence and clinical complications PI3K inhibitors ic50 of ISR of the randomized controlled trials comparing CAS and CEA [4], [6] and [11] are eagerly awaited. The unresolved clinical impact of ISR further highlights the importance to identify independent risk factors which are predictive http://www.selleckchem.com/products/LBH-589.html for an ISR. These would be helpful to detect those patients in which a tight follow up is necessary. Advanced age [17] and [19] has been found to be predictive for an ISR, which would further contribute to the recommendation of choosing a CEA as a first treatment of choice especially in elderly patients [3] and [5]. CAS is frequently recommended in patients with a restenosis after CEA because a redo-CEA sometimes appears to be technically difficult and might

bear a higher periprocedural risk than the initial operation [7] or in patients with a radiogenic stenosis [45]. When considering the optimal treatment option for those patient subgroups, one

should take into account though that a CAS procedure because of a CEA-restenosis or radiation-induced stenosis is also associated with a higher rate of ISR [20], [23], [34] and [35]. An insufficient result after a CAS procedure, e.g. due to insufficient stent adaptation, could be shown to be associated with a higher risk of ISR occurrence [19], [20] and [28]. Therefore, to ameliorate the long-term benefit of a CAS, it is a worthwhile aim to pursue a perfect stent adaptation to the vessel lumen. The fact that an aggressive postdilation bears the risk of distal embolization and microvascular injury, which may itself initiate neointimal hyperplasia complicates the procedure. Furthermore, the characteristics of the stent deployed are of special interest regarding the incidence of ISR. Usually, the selection Tenoxicam of the stent length and width are based on angiographic findings in order to appropriately cover the stenosis. However, narrower and longer stents were correlated with a higher ISR risk [28] and [30]. It is conceivable that a stent with a larger diameter results in a reduced flow-velocity, less turbulences and thus in less frequent ISR. A longer stent, which is used to cover longer lesions, probably represents the presence of a high plaque burden and has repeatedly been identified as an independent predictor for periprocedural complications [46] and [47].