A rational approach to recurrent carotid stenosis

To further characterize the incidence and morbidity of recurrent carotid stenosis, we reviewed 184 consecutive carotid endarterectomies performed in a university hospital between August 1983 and January 1988, in patients followed after operation with serial duplex ultrasonography. Recurrent stenosis of greater than 50% diameter reduction developed in eleven arteries (6.0%) at a mean interval of 10.2 +/- 7.8 months. Three of the eleven (1.6% of the total) had associated transient ischemic attack, and none had strokes. Restenosis was significantly more frequent in diabetic patients than in nondiabetic patients (13.3% vs 4.5%; p less than 0.05); and among patients whose primary stenoses had been symptomatic compared to asymptomatic (11.0% vs 1.5%; p less than 0.02). No statistically significant association with restenosis could be established for gender, hypertension, or smoking. Completion angiography and/or Doppler spectral analysis had been performed, and results were normal at the primary operation in 10 of the 11 patients. Only six of 184 arteries (3.3%) had vein patch closure, but none of these restenosed. Uneventful reoperation with patch closure was performed in three patients with transient ischemic attacks and two with preocclusive restenoses. Lesions were myointimal hyperplasia in four and atheroma in one. Three of the unoperated restenoses have shown regression on duplex scanning, but a fourth progressed to asymptomatic occlusion. Carotid restenosis is uncommon, even without routine use of vein patch angioplasty. Reoperation should be reserved for patients with associated symptoms or greater than 80% restenosis.