Introduction Endovascular and surgical treatment of stenosis of the internal carotid artery (ICA) inherit a certain risk of restenosis due to endothelial hyperplasia. Drug-coated balloons (DCBs) are designed to reduce neointimal hyperplasia by transferring growth-inhibiting drugs to the endothelium, but they are rarely used in the neurovascular setting.

Aim of Study: Assess the effectiveness of DCB and determine the frequency of recurrent ISRS, and factors that may influence its occurrence.

Methods In our center between 2010 and 2023, 109 patients received DCB treatment for in-stent restenosis of ICA. Their medical history, periprocedural, and follow-up data were analyzed. All patients received periodical follow-up through digital subtraction angiography, ultrasound examinations and tomographic imaging.

Results ISRS was diagnosed in the mean follow-up time of 18.7 months (1–180 months) following carotid artery stenting. In-hospital major stroke complication occurred in 1 patient (0.9%). No minor stroke or TIA occurred, yet, in 23 patients (21.1%) clinically inapparent DWI-lesions were detected in postprocedural MRI. 17 patients (15.6%) had recurrent ISRS after DCB treatment in the mean follow-up period of 30.8 months (7–85 months). Diabetes mellitus and tobacco use were common risk factors for recurrent ISRS. The DCB treatment with Sequent® Please NEO resulted in a lower incidence of recurrent ISRS and a longer time-to-restenosis.

Conclusion In our practice, DCB offers a straightforward option to treat restenosis of the ACI ostium. The low rate of periprocedural complications and the median time of freedom from symptoms and/or restenosis suggest that DCB angioplasty for ISRS is a viable treatment.

Disclosure of Interest Nothing to disclose