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Long-term follow-up and clinical outcome of carotid restenosis
D A Healy1, R E Zierler, S C Nicholls
1Department of Surgery, University of Washington School of Medicine, Seattle.
Insights
Carotid restenosis after surgery is common, affecting 21% within 7 years, and occurs more in women. However, restenosis rarely leads to stroke or transient ischemic attacks, justifying conservative management.
Area of Science:
- Vascular Surgery
- Neurology
Background:
- Carotid endarterectomy (CEA) efficacy depends on preventing stroke and managing restenosis.
- Long-term outcomes of CEA are influenced by recurrent stenosis and its complications.
Purpose of the Study:
- To investigate the long-term effects and prevalence of carotid restenosis after CEA.
- To assess the association between restenosis and neurological events (stroke, TIA) and survival.
Main Methods:
- Serial duplex scanning was used to monitor 301 patients post-CEA for an average of 4 years.
- Life-table analysis calculated cumulative incidence of restenosis and regression.
- Restenosis was defined as ≥50% diameter reduction.
Main Results:
- Cumulative incidence of restenosis at 7 years was 31%, with 10% regression, resulting in a 21% prevalence.
- Restenosis occurred significantly more in women (p=0.01).
- No statistically significant difference in stroke or TIA incidence was observed between patients with and without restenosis.
Conclusions:
- Carotid restenosis typically develops early post-CEA and often regresses or stabilizes.
- A conservative treatment approach is warranted due to the low risk of neurological events associated with restenosis.
- Long-term survival was not impacted by the presence of restenosis.
Abstract:
The efficacy of carotid endarterectomy is dependent on the inherent ability of the operation to prevent stroke as well as the incidence of restenosis and associated symptoms. To examine the long-term effects of restenosis, 301 patients having carotid endarterectomy were followed by serial duplex scanning for an average of 4 years. Carotid restenosis, defined as 50% or greater diameter reduction by duplex scanning, occurred after 78 of the endarterectomies; regression of recurrent stenosis occurred in 20 arteries. By life-table analysis the cumulative incidence of restenosis at 7 years was 31%, and the cumulative incidence of regression was 10%. Thus the prevalence of recurrent stenosis at 7 years was 21%. Restenosis developed in women more frequently than men (p = 0.01). Transient ischemic attack occurred in 12% of patients with restenosis, and stroke occurred in 3%; however, the cumulative incidence of stroke or transient ischemic attack was not statistically different in those patients with and without restenosis. Similarly, cumulative survival at 7 years was no different. Carotid restenosis usually occurs early in the postoperative period and tends to regress or remain stable during long-term follow-up. A conservative approach to treatment appears justified, since transient ischemic attacks and stroke were rarely associated with restenosis.