Abstract
Current options for treating recurrent carotid stenosis (RCS) include standard longitudinal arteriotomy and patch angioplasty with or without carotid endarterectomy (s-PCEA), carotid-carotid bypass, or carotid angioplasty and stent (CAS). Eversion carotid endarterectomy (e-CEA) is an effective procedure for treating primary carotid stenosis, yet it has not been reported for treating RCS. We evaluated the feasibility and outcome of e-CEA for treating of RCS in comparison to s-PCEA. The records of all patients undergoing elective CEA for symptomatic and asymptomatic high-grade RCS from January 1981 to July 2002 were reviewed. Although during the earlier period s-PCEA was performed preferentially, this paradigm changed to e-CEA being the preferred technique for treatment of RCS. During the course of postoperative follow-up when duplex sonography suggested high-grade RCS, the diagnosis was confirmed via arteriography. Data on cranial nerve injury, recurrent stenosis, stroke, and death were prospectively collected into a vascular registry database and analyzed retrospectively, Students’ t-test and chi-square analysis were used to compare the group’s baseline characteristics and outcomes. Over a 21-year period, 7001 patients underwent primary CEA for symptomatic (n = 2405, 34%) or asymptomatic (n = 4596, 66%) high-grade stenosis via standard (n = 1501, 21%) or eversion (n = 5500, 79%) techniques. Fifteen (25%) patients had 70 to 80% stenosis, 30 (51%) had 81 to 90% stenosis, and 14 (24%) had 91 to 99% stenosis. During this time period, 59 patients presented with symptomatic (n = 18, 31%) or asymptomatic (n = 41, 69%) high-grade RCS and underwent operative repair via s-PCEA (n = 22, 37%) or eversion (n = 37, 63%) techniques. The mean time interval for repeat carotid surgery for RCS was 49 months in the s-PCEA group and 48 months in the e-CEA group. Permanent cranial nerve injuries, stroke, and recurrent restenosis occurred in one (4.5%), one (4.5%), and one (4.5%) of the patients undergoing s-PCEA, respectively. In the e-CEA group, these events occurred in one (27%), none (0%), and one (2.7%) patients, respectively, There were no deaths during the 30-day postoperative period. Eversion CEA is a feasible option for the treatment of many RCSs and can be performed safely with a low rate of cranial nerve injury, recurrent stenosis, stroke, and death.
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References
InstitutionalAuthorNameNorth American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) ArticleTitleBeneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis N Engl J Med 325 445–453
InstitutionalAuthorNameExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) ArticleTitleEndarterectomy for asymptomatic carotid artery stenosis J A M A 273 1421–1428
RJ Stoney ST String (1976) ArticleTitleRecurrent carotid stenosis Surgery 80 705–710
DA Healy RE Zierler SC Nicholls et al. (1989) ArticleTitleLong term follow-up and clinical outcome of carotid restenosis J Vasc Surg 10 662–669
RD Degroote TG Lynch Z Jamil RW Hobson SuffixII (1987) ArticleTitleCarotid restenosis: long term noninvasive follow-up after carotid endarterectomy Stroke 18 1031–1036
AD Callow (1982) ArticleTitleRecurrent stenosis after carotid endarterectomy Arch Surg 117 1082–1085
MA Mattos KJ Hodgson GL Londrey et al. (1992) ArticleTitleCarotid endarterectomy: operative risks, recurrent stenosis, and long term stroke rates in a modern series J Cardiovasc Surg 33 387–400
GS Treiman JM Jenkins WH Edwards et al. (1992) ArticleTitleThe evolving surgical management of recurrent carotid artery stenosis J Vasc Surg 16 354–363
MD Das NR Hertzer NB Ratliff PJ O’Hara EG Bennen (1985) ArticleTitleRecurrent carotid stenosis: a five year series of 65 operations Ann Surg 202 28–35
EY Vhakhtoura RW Hobson SuffixII J Goldstein et al. (2001) ArticleTitleIn-stent restenosis after carotid angioplasty-stenting: incidence and management J Vasc Surg 33 220–226
RC Darling SuffixIII PS Paty DM Shah BB Chang RP Leather (1996) ArticleTitleEversion endarterectomy of the internal carotid artery: technique and results in 449 procedures Surgery 120 635–640
JR Avramovic JP Fletcher (1992) ArticleTitleThe incidence of recurrent carotid stenosis after carotid endarterectomy and its relationship to neurological events J Cardiovasc Surg 33 54–58
WK Washburn WC Mackey M Belkin TF O’Donnell SuffixJr (1992) ArticleTitleLate stroke after carotid endarterectomy: the role of recurrent stenosis J Vasc Surg 15 1032–1037
DM Shah RC Darling SuffixIII BB Chang et al. (1998) ArticleTitleCarotid endarterectomy by eversion technique: its safety and durability Ann Surg 228 471–478
P Cao G Giordano P Rango et al. (2000) ArticleTitleEversion versus conventional carotid endarterectomy: late result of a prospective multicenter randomized trial J Vasc Surg 31 19–30
E Ballotta DG Giuseppe C Baracchini R Manara (2002) ArticleTitleCarotid eversion endarterectomy: perioperative outcome and restenosis incidence Ann Vasc Surg 16 422–429
SP Roddy RC Darling SuffixIII K Ozsvath et al. (2002) ArticleTitleChoice of material for internal carotid artery bypass grafting: vein or prosthetic? Analysis of 44 procedures J Cardiovasc Surg 10 540–544
PJ Gange TS Riles GR Jacobowitz et al. (1993) ArticleTitleLong term follow-up of patients undergoing reoperation for recurrent carotid artery disease J Vasc Surg 18 991–998
BB Hill C Olcott RL Dalman EJ Harris SuffixJr CK Zarins (1999) ArticleTitleReoperation for carotid stenosis is as safe as primary carotid endarterectomy J Vasc Surg 30 26–35
CB Rockman TS Riles R Landis et al. (1999) ArticleTitleRedo carotid surgery: an analysis of materials and configurations used in carotid reoperations and their influence of perioperative stroke and subsequent recurrent stenosis J Vasc Surg 29 72–81
TF O’Donnell SuffixJr AA Rodriguez JE Fortunate HJ Welch WC Mackey (1996) ArticleTitleManagement of recurrent carotid stenosis: should asymptomatic lesions be treated surgically? J Vasc Surg 24 207–212
JJ Ricotta MS O’Brien-Irr (1997) ArticleTitleConservative management of residual and recurrent lesions after carotid endarterectomy: long term results J Vasc Surg 26 963–972
AF AbuRahma MC Bates PA Stone JT Wulu (2001) ArticleTitleComparative study of operative treatment and percutaneous transluminal angioplasty/stenting for recurrent carotid disease J Vasc Surg 34 831–838
AR Leger M Neale JP Harris (2001) ArticleTitlePoor durability of carotid angioplasty and stenting for treatment of recurrent artery stenosis after carotid endarterectomy: an institutional experience J Vasc Surg 33 1008–1014
EB Dietrich M Ndiye BD Reid (1996) ArticleTitleStenting in the carotid artery: initial experience in 110 patients J Endovasc Surg 3 42–62
JS Yadav MH Wholey RE Duntz et al. (2004) ArticleTitleProtected carotid-artery stenting versus endarterectomy in high-risk patients N Engl J Med 351 1493–1501
MH Wholey M Wholey P Bergeron et al. (1998) ArticleTitleCurrent global status of carotid artery stent placement Cathet Cardiovasc Diagn 44 1–6
DL Fischeman MB Leon DS Baim et al. (1994) ArticleTitleA randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease N Engl J Med 331 496–501
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Mehta, M., Roddy, S.P., Darling, R.C. et al. Safety and Efficacy of Eversion Carotid Endarterectomy for the Treatment of Recurrent Stenosis: 20-Year Experience. Ann Vasc Surg 19, 492–498 (2005). https://doi.org/10.1007/s10016-005-0008-2
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DOI: https://doi.org/10.1007/s10016-005-0008-2