FIG 2. A case of multiple restenting in patient 2, a 61-year-old man with bilateral radical neck dissection and external beam radiation for laryngeal cancer 15 years before right cerebral hemisphere stroke due to right ICA occlusion.

A, DSA shows an 85% ulcerated stenosis (arrow) of the proximal left ICA.

B, DSA after angioplasty and stent placement shows little residual stenosis. Prestent angioplasty was performed with a 4 x 20 mm Symmetry balloon (Boston Scientific). This was followed by placement of an 8 x 40 mm Wallstent (Boston Scientific). Poststent angioplasty was performed by using an 8 x 40 mm Olbert balloon (Boston Scientific).

C, Repeat DSA 5 years after stent placement shows 70% restenosis (arrow) in the distal left CCA at the inferior margin of the stent. The external carotid artery no longer fills.

D, DSA after angioplasty and stent placement with a 5 x 20 mm Savvy balloon (Cordis Corp., Miami Lakes, FL) followed by a 7 x 20 mm Precise stent (Cordis). There is minimal filling of the external carotid artery.

E, DSA 17 months later shows a focal high-grade in-stent restenosis (arrow) and a less severe stenosis in the CCA (arrowhead).

F, Immediate DSA following placement of a third stent (7 x 40 mm Precise; Cordis) and poststent angioplasty with a 6 x 40 Savvy balloon (Cordis) shows a good angiographic result.