Carotid artery restenosis: an ongoing disease process

Recurrence of carotid artery stenosis after primary endarterectomy is a well-known entity. The treatment and optimal management of the disease process, however, is a matter of ongoing debate. We retrospectively reviewed carotid endarterectomies for recurrent disease performed at a community hospital over the past 21 years to evaluate the outcome of surgical intervention. Eighty-two recurrences occurred in 1648 carotid endarterectomies. Females had a slightly higher recurrence rate as compared with males, and the majority of patients had risk factors in the form of hypertension, peripheral vascular disease, or cigarette smoking. All endarterectomies were repaired with a patch angioplasty by either a vein or a prosthetic graft. One patient died secondary to complications of coronary artery disease. None of the patients developed any postoperative neurological event or permanent nerve damage. A subgroup of 11 patients with recurrent carotid artery stenosis with contralateral occlusion underwent 14 endarterectomies with no neurological complications. In conclusion occlusive carotid disease is an ongoing phenomenon, and continued surveillance is recommended. Surgical treatment of recurrent disease is a safe option. Endarterectomies for recurrent carotid disease in the presence of contralateral occlusion can be performed safely.