In-Stent Restenosis of Carotid and Vertebral Arteries Treated by Angioplasty Using a Cutting Balloon: A Case Report

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Objective: We treated a patient with internal carotid artery and vertebral artery ostium in-stent restenosis (ISR) treated by cutting balloon (CB) angioplasty.

Case Presentation: A 79-year-old man developed dizziness and right homonymous upper quadrantanopia. On arrival, magnetic resonance imaging (MRI) revealed acute-stage brain infarction. Angiography demonstrated left internal carotid artery and vertebral artery ostium stenosis (VAOS), which was thought to be related to the infarction. We performed stenting for both lesions, but 5 months later, restenosis occurred. The patient was successfully retreated by CB angioplasty for both lesions.

Conclusion: When treating carotid or vertebral artery ISR, plain balloon (PB) and stent-in-stent (SIS) procedures may induce insufficient dilatation, and hamper re-retreatment because of neointimal hyperplasia. Using CB should be considered as an option in such cases.