Related Experiment Videos
Reoperation for carotid stenosis is as safe as primary carotid endarterectomy
B B Hill1, C Olcott, R L Dalman
1Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA, USA.
Insights
Reoperative carotid surgery for recurrent stenosis has similar stroke and death rates compared to primary carotid endarterectomy. This study found that redo carotid surgery is a safe and effective treatment option.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Recurrent carotid artery stenosis may be treated with angioplasty and stenting due to concerns about higher complication rates with reoperation.
- Primary carotid endarterectomy is a standard procedure for carotid stenosis.
Purpose of the Study:
- To compare the outcomes of primary carotid endarterectomy with reoperative carotid surgery for recurrent stenosis.
- To determine if carotid reoperation carries a higher complication rate than primary surgery.
Main Methods:
- A retrospective review of medical records for all carotid operations performed between September 1993 and March 1998.
- Comparison of outcomes between primary carotid endarterectomy (n=350) and reoperative carotid surgery (n=40).
Main Results:
- The overall stroke/death rate for all 390 carotid operations was 0.8%.
- No significant difference in stroke-death rates was observed between primary endarterectomy (1.1% stroke rate) and reoperative surgery (0% stroke rate).
- Reoperative surgery had a higher mean cost ($13,700 vs. $9700) primarily due to increased cerebral angiography use.
Conclusions:
- Operation for recurrent carotid stenosis is as safe and effective as primary carotid endarterectomy.
- Reoperative carotid surgery should remain a standard treatment option for recurrent carotid stenosis.
- Procedure-related stroke/death rates are low for both primary and reoperative carotid endarterectomy.
Purpose:
Patients with recurrent carotid artery stenosis are sometimes referred for carotid angioplasty and stenting because of reports that carotid reoperation has a higher complication rate than primary carotid endarterectomy. The purpose of this study was to determine whether a difference exists between outcomes of primary carotid endarterectomy and reoperative carotid surgery.
Methods:
Medical records were reviewed for all carotid operations performed from September 1993 through March 1998 by vascular surgery faculty at a single academic center. The results of primary carotid endarterectomy and operation for recurrent carotid stenosis were compared.
Results:
A total of 390 operations were performed on 352 patients. Indications for primary carotid endarterectomy (n = 350) were asymptomatic high-grade stenosis in 42% of the cases, amaurosis fugax and transient ischemic symptoms in 35%, global symptoms in 14%, and previous stroke in 9%. Indications for reoperative carotid surgery (n = 40) were symptomatic recurrent lesions in 50% of the cases and progressive high-grade asymptomatic stenoses in 50%. The results of primary carotid endarterectomy were no postoperative deaths, an overall stroke rate of 1.1% (three postoperative strokes, one preoperative stroke after angiography), and no permanent cranial nerve deficits. The results of operations for recurrent carotid stenosis were no postoperative deaths, no postoperative strokes, and no permanent cranial nerve deficits. In the primary carotid endarterectomy group, the mean hospital length of stay was 2.6 +/- 1. 1 days and the mean hospital cost was $9700. In the reoperative group, the mean length of stay was 2.6 +/- 1.5 days and the mean cost was $13,700. The higher cost of redo surgery is accounted for by a higher preoperative cerebral angiography rate (90%) in redo cases as compared with primary endarterectomy (40%).
Conclusion:
In this series of 390 carotid operations, the procedure-related stroke/death rate was 0.8%. There were no differences between the stroke-death rates after primary carotid endarterectomy and operation for recurrent carotid stenosis. Operation for recurrent carotid stenosis is as safe and effective as primary carotid endarterectomy and should continue to be standard treatment.