Elsevier

Journal of Vascular Surgery

Volume 47, Issue 2, February 2008, Pages 363-371
Journal of Vascular Surgery

Clinical research study
Durability of surgery for restenosis after carotid endarterectomy

https://doi.org/10.1016/j.jvs.2007.10.002Get rights and content
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Background

The role of carotid surgery for the management of restenosis after carotid endarterectomy (CEA) is challenged by carotid artery stenting (CAS). We reviewed redo CEA in a consecutive series of patients to determine the safety, durability, and long-term benefit associated with repeat surgical treatment for restenosis.

Methods

A consecutive series of 73 redo procedures in 72 patients (57% men) with a mean age 66 years (range, 49-81 years) was analyzed. The mean interval between prior CEA and redo CEA was 53 months (range, 8-192 months). Operative indications included symptomatic restenosis in 28 patients (38%). A patch angioplasty was performed in 62 patients (85%). The main outcome measures included perioperative and late stroke and death, and the development of secondary restenosis.

Results

There were no perioperative deaths or strokes. During a mean follow-up of 52 months (range, 12-144 months), the Kaplan-Meier cumulative survival was 85% at 5 years. At 5 years, the cumulative rate of freedom from all strokes was 98%, and the freedom from ipsilateral stroke was 100%. After secondary procedures, re-recurrent stenosis ≥50% occurred in 10 patients (13.7%). The cumulative freedom from re-restenosis (≥50%) was 85% at 5 years. Five patients (7%) received tertiary carotid reconstructions.

Conclusion

Repeat CEA for recurrent stenosis can be performed safely with excellent long-term protection from stroke. These data provide a standard against which the results of CAS can be compared.

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Competition of interest: none.