This study defined outcomes after carotid reoperation (CREOP) and stenting (CAS) for restenosis after ipsilateral carotid endarterectomy (CEA) and compared results between CREOP and primary CEA. All patients undergoing carotid procedure for restenosis (2003-2014) were retrospectively reviewed (CREOP, CAS). A 1:2 case-control match for age, gender, procedure side, symptom, surgical risk, and year was performed between CREOP and patients undergoing primary CEA for >70% carotid stenosis for high-risk (hCEA) and low-risk groups (lCEA). Primary end points were composite stroke and death and ipsilateral stroke; secondary end points were death, any stroke, and myocardial infarction (MI). A total of 166 carotid procedures in 164 patients (female: 40%; mean age: 69 ± 8.3 years) were included (CREOP: 29, CAS: 47, hCEA1: 58, lCEA2: 58). Symptomatic patients were more frequent in CREOP than CAS (41% vs 15%; P = .01). Median time from ipsilateral CEA to CREOP or CAS was 3.6 years (range, 33 days-19.1 years) and 1.7 years (range, 35 days-20.8 years), respectively (P = .71). There were no early deaths or strokes after CREOP. Thirty-day composite stroke and death rates were 0%, 4.3%, 3.5%, and 1.7 for CREOP, CAS, hCEA, and lCEA, respectively. Ipsilateral stroke was 0%, 4.3%, 1.9%, and 0% for the four groups. For the same four groups, mortality was 0%, 2.1%, 1.7%, and 1.7%; any stroke was 0%, 4.3%, 1.7%, and 0%; and MI was 6.9%, 0%, 3.5%, and 1.7% (P > .05). Results were similar between CREOP and the other three groups regardless of symptoms (Table). In asymptomatic patients, hospital stay was the longest for CREOP (P > .05). Early complications were higher in CREOP in both asymptomatic (29% vs 5.9%; P = .03) and symptomatic patients (67% vs 25%; P = .03) compared to lCEA, but similar to hCEA. Over an average follow-up of 5.2 ± 4.1 years, 5-year composite stroke and death was 31%, 20%, 40%, and 15% for CREOP, CAS, hCEA, and lCEA, respectively. Five-year ipsilateral stroke was 0%, 4.3%, 7.4%, and 0% (P > .05). However, composite stroke and death was higher in symptomatic CREOP patients compared to lCEA (P = .049, Table). There were no early or late differences in primary end points between CREOP and CAS. Composite stroke and death, and ipsilateral stroke, are similar between reoperative carotid surgery and CAS for recurrent carotid stenosis. However, redo carotid surgery can be performed safely in both asymptomatic and symptomatic patients, with similar early stroke or death as primary CEA. CAS carries low early stroke or death in asymptomatic patients. There were too few symptomatic patients to determine its risk.TableOutcomes after carotid procedure in asymptomatic and symptomatic patientsVariableAsymptomaticSymptomaticCREOPn = 17n (%)CASn = 40n (%)hCEAn = 34n (%)lCEAn = 34n (%)P valueaP valuebP valuecCREOPn = 12n (%)CAS n = 7n (%)hCEA n = 24n (%)lCEAn = 24n (%)P valueaP valuebP valuecProcedure time (min)199 ± 61202 (121-309)81 ± 2977 (45-205)177 ± 51175 (90-241)162 ± 54160 (62-323)<.001.18.03271 ± 86291 (112-418)110 ± 5092 (58-211)188 ± 36190 (127-250)172 ± 26170 (121-219)<.001<.001<.00130-day outcomes LOS (day)2.2 ± 1.72 (1-7)1.3 ± 0.71 (0-5)1.5 ± 0.81 (1-4)1.4 ± 0.61 (0-3).003.04.0082.3 ± 1.92 (1-8)3.6 ± 3.53 (1-11)2.9 ± 2.32 (1-8)1.9 ± 1.81 (1-8).32.48.49 Composite stroke and death0 (0)1 (2.5)0 (0)0 (0)1.00……0 (0)1 (14)2 (8.3)1 (4.2).37.541.00 Mortality0 (0)1 (2.5)0 (0)0 (0)1.00……0 (0)0 (0)1 (4.2)1 (4.2)…1.001.00 Any stroke0 (0)1 (2.5)0 (0)0 (0)1.00……0 (0)1 (14)1 (4.2)0 (0).371.00… Ipsilateral stroke0 (0)1 (2.5)0 (0)0 (0)1.00……0 (0)1 (14)1 (4.2)0 (0).371.00… MI0 (0)0 (0)0 (0)0 (0)………2 (17)0 (0)2 (8.3)1 (4.2).51.59.25 Complication5 (29)5 (13)7 (21)2 (5.9).15.50.038 (67)3 (43)12 (50)6 (25).38.48.03 Cranial nerve injury0 (0)0 (0)1 (2.9)0 (0)…1.00…3 (25)0 (0)1 (4.2)0 (0).26.10.03 Reintervention0 (0)0 (0)1 (2.9)0 (0)…1.00…1 (8.3)0 (0)3 (13)2 (8.3)1.001.001.005-year outcomes Composite stroke and death21213517.94.32.8346144613.49.83.049 Survival79796482.94.33.80731005887.54.53.36 Any stroke02.53.53.1.40.37.392214170.91.47.02 Ipsilateral stroke02.500.40……014170.16.18– Freedom from reintervention839697100.34.21.0376608791.55.71.40CAS, Carotid artery stenting for carotid restenosis; hCEA, all high-risk primary carotid endarterectomy; lCEA, primary carotid endarterectomy excluding prior ipsilateral CEA as a high-risk; CREOP, carotid reoperation for restenosis; LOS, length of stay; MI, myocardial infarction.aCREOP vs CAS.bCREOP vs hCEA.cCREOP vs lCEA. Open table in a new tab