2023 Volume 51 Issue 3 Pages 257-261
Recently, endovascular approach is the first choice for retreatment after carotid artery stenting (CAS), whereas the direct surgical approach is rarely selected. In this report, we described two cases of direct surgical treatment for early and late complications after CAS because of the refractoriness to multiple endovascular interventions. In the case with an early complication after CAS, symptomatic plaque protrusion was observed, and carotid stents were removed, followed by standard carotid endarterectomy. In the case with a late complication after CAS, symptomatic in-stent restenosis was noted, and a surgical en bloc excision of the involved segment, including stents, was performed, followed by carotid bypass using a synthetic interposition graft. In both cases, the postoperative course was uneventful. Thus, a direct surgical approach is an effective retreatment strategy for both early and late-stage complications after CAS and should be considered without hesitation, especially in case of refractoriness to multiple endovascular interventions.