Objective
The purpose of the study was to evaluate the results of reoperative surgery and carotid
artery stenting (CAS) in cases of recurrent carotid artery stenosis (RCS) and to compare
the results of all RCS (reoperative surgery + CAS) with primary carotid endarterectomy
(CEA) performed during the study period.
Summary Background Data
Consensus has not yet been established on the best treatment for RCS. Recently CAS
has emerged as a potential alternative to carotid endarterectomy.
Methods
A 6-year (Jan 2000-Dec 2005) prospective study was performed. Eligible patients were
those with symptomatic or asymptomatic RCS ≥80% at a preoperative angiography or angio-computed
tomography. The carotid plaques were classified at a preoperative ultrasonographic
scan, according to the five type classification proposed by Geroulakos (Br J Surg
1993;80:1274-7). Patients with type 1 and 2 carotid plaque were not considered for
CAS.
Results
56 patients were enrolled. Fifteen patients with a type 1-2 plaque underwent reoperative
surgery, 41 with type 3-4 plaque underwent CAS. In 90.6% of primary closure a type
3-4 carotid plaque was found; a type 1-2 was observed in 84.5% of the polytetrafluoroethylene
patch closure group. No statistical difference for the 30-day and the 6 year stroke-free
rate was observed; similarly no differences emerged between all RCS (reoperative surgery
+ CAS) performed and primary CEA.
Conclusions
CAS is an acceptable alternative to surgery in the management of RCS. An accurate
patient selection is required. Restenosis after CEA and direct closure is mostly associated
with fibrous material. In these cases CAS might be the best choice.
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Article info
Publication history
Published online: November 30, 2007
Accepted:
June 2,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
