Early recurrent carotid artery stenosis

Abstract

IntroductionEarly recurrent carotid artery stenosis, defined as stenosis occurring within 2 years of carotid endarterectomy, occurs in 4% to 36% of patients. Management of asymptomatic early recurrent stenosis is controversial because of different outcomes in multiple natural history studies. Optimal follow-up post–carotid endarterectomy has not been defined. The purpose of this study was to determine the natural history of early recurrent stenosis and to define the optimal duplex surveillance strategy during follow-up. MethodsPatients who underwent carotid endarterectomy between January 1995 and June 1998 at a single tertiary-care institution were reviewed retrospectively. Data were collected regarding degree of stenosis, closure technique, neurologic morbidity, mortality, and the intervals between postoperative duplex studies. These results were compared with accepted rates in the literature. Life-table analysis was done on restenosis-free survival. Discrete variables were tested for significance by chi-square analysis and Fisher’s exact test. A p value less than or equal to 0.05 was considered significant. ResultsTwo hundred thirty-one carotid endarterectomies in 226 patients were evaluated. A total of 57 (24.6%) of 231 carotid endarterectomies had recurrent stenosis. These 57 sites were in 56 patients. Fifty-four (23.4%) of 231 sites had a stenosis of 16% to 59%. All of these lesions were asymptomatic and found within 1 year of carotid endarterectomy on duplex imaging. The 3 (1.3%) remaining sites had a restenosis of greater than 60%. Early recurrent stenosis occurred more frequently in women (women 28/80 [35%] vs. men 28/146 [19.2%]). High-grade stenosis occurred more often with primary (1/5 [20%]) than with patch (2/226 [0.8%]) closure and in patients less than 65 years of age.