Operative intervention for carotid restenosis is safe and effective.

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Recurrent carotid stenosis after initial endarterectomy poses a significant clinical challenge.
• Carotid stenting is an alternative, but reoperation remains a crucial treatment option.

Purpose of the Study:

• To evaluate the long-term safety, effectiveness, and durability of reoperative carotid endarterectomy (rCEA) for recurrent carotid stenosis.
• To analyze factors influencing the time to reoperation and long-term outcomes.

Main Methods:

• Retrospective analysis of 83 rCEA procedures in 80 patients over 18 years (1988-2005).
• Indications included symptomatic stenosis, asymptomatic high-grade stenosis, intimal flap, and fibromuscular dysplasia.
• Follow-up included clinical assessment, imaging, and Kaplan-Meier survival analysis.

Main Results:

• No perioperative strokes or deaths; low operative morbidity (nerve injury, hematoma).
• Long-term stroke-free rates at 153 months were 98.67% (hemispheric) and 95.85% (all-stroke).
• Statin therapy and combined statin-aspirin significantly increased the interval to reoperation; increased age correlated with decreased time to reoperation.

Conclusions:

• Reoperative carotid endarterectomy is a safe, effective, and durable treatment for recurrent carotid stenosis.
• Standard vascular techniques for rCEA should remain the primary treatment when secondary intervention is needed.
• Statins demonstrate a positive impact on the durability of rCEA and should be considered for indicated patients.