Carotid artery in-stent restenosis in a patient with contralateral total occlusion, resolved with drug-eluting stenting.

A 70-year-old male patient with 90% stenosis of the right carotid artery and total occlusion of the left carotid artery underwent right carotid stenting. Two weeks after the procedure, the patient experienced grand mal seizures, and had angioplasty after 6 and 11 months, respectively, for recurrent in-stent restenosis. During drug-eluting stent deployment, the patient developed acute stent thrombosis, but he recovered quickly and completely after local thrombolysis and balloon angioplasty. For the 1 year of follow up to date, the patient has been symptom-free and without restenosis. At 6 months from the last-mentioned study, the patient was admitted for intermittent claudication, fatigability and severe hypertension. A Doppler study of the carotid stent showed normal velocities, and the the neurological exam was similar to the previous one. Angiography confirmed bilateral ostial stenosis of the renal arteries and we performed bilateral renal stenting at that time.