Recurrent carotid artery stenosis: natural history and predisposing factors. A long-term follow-up study

The aim of this study was to evaluate the impact of various risk factors, excluding the type of closure of the arteriotomy, on the development of recurrent carotid stenosis after carotid endarterectomy.

single-center, open prospective.

Three hundred and eight patients, who underwent a total of 338 carotid endarterectomies, were evaluated postoperatively with color duplex 1 month after the operation and every 6 months thereafter, the mean duration of follow-up being 52 months (range: 6-144). Only patients submitted to primary closure of the arteriotomy were included. Statistical analysis was performed using the Kaplan Meier method, the log rank test and Cox regression analysis.

Three patients (0.9%) died during the perioperative period. Three (0.9%) patients had a transient ischemic attack and 7 (2.1%) a nonfatal stroke. Recurrent carotid stenosis of >50% was identified in 11 patients, leading to a 21.6% cumulative restenosis rate at 10 years of follow-up. Only one of the 11 patients with restenosis developed neurological symptoms during the follow-up period. Both univariate and multivariate analyses showed that coronary artery disease was significantly associated with restenosis, while patients with uniformly echogenic plaques as well as those with hypercholesterolemia showed a lower incidence of restenosis.

The cumulative recurrent stenosis rate following carotid endarterectomy was 21.6% at 10 years of follow-up. Restenosis was symptomatic in 1 patient. Coronary artery disease was associated with an increased risk of restenosis, while uniformly echogenic plaques and hypercholesterolemia were associated with a lower risk.