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.
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.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis.N Engl J Med. 1991; 325: 445-453
- Endarterectomy for asymptomatic carotid artery stenosis.JAMA. 1995; 273: 1421-1428
- Long-term follow-up and clinical outcome of carotid restenosis.J Vasc Surg. 1989; 10: 662-669
- Management of recurrent carotid stenosis: should asymptomatic lesions be treated surgically?.J Vasc Surg. 1996; 24: 207-212
- Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature.Stroke. 1998; 29: 244-250
- An outcome analysis of carotid endarterectomy: the incidence and natural history of recurrent stenosis.J Vasc Surg. 1996; 23: 749-754
- Hemodynamically significant early recurrent carotid stenosis: an often self-limiting and selfreversing condition.J Vasc Surg. 1999; 30: 446-452
- Redo carotid endarterectomy versus primary carotid endarterectomy.Stroke. 2001; 32: 2787-2792
- Angioplasty and stenting for restenosis after carotid endarterectomy.Stroke. 1996; 27: 2075-2079
- Safety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy: a multicenter study.J Endovasc Therapy. 2000; 7: 345-352
- Carotid restenosis: operative and endovascular management.J Vasc Surg. 1999; 29: 228-238
- Comparative study of operative treatment and percutaneous transluminal angioplasty/stenting for recurrent carotid disease.J Vasc Surg. 2001; 34: 831-838
- Outcome of carotid stent-assisted angioplasty versus open surgical repair of recurrent carotid stenosis.J Vasc Surg. 2003; 38: 432-438
- Stratified gray-scale median analysis and color-mapping of the carotid plaque: correlation with endarterectomy specimen histology of 28 patients.Stroke. 2005; 36: 741-745
- Carotid plaque echolucency increases the risk of stroke in carotid stenting: the Imaging in Carotid Angioplasty and Risk of Stroke (ICAROS) study.Circulation. 2004; 110: 756-762
- The vulnerable carotid artery plaque: current imaging methods and new perspectives.Stroke. 2005; 36: 2764-2772
- Characterization of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography.Br J Surg. 1993; 80: 1274-1277
- Carotid endarterectomy without angiography: a prospective randomised pilot study.Eur J Vasc Endovasc Surg. 2000; 20: 250-253
- Carotid plaque: comparison between visual and grey-scale median analysis.Ultrasound Med Biol. 2003; 29: 961-966
Published online: November 30, 2007
Accepted: June 2, 2007
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.