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Carotid endarterectomy. Long term follow-up with specific reference to recurrent stenosis, contralateral progression,
Insights
Carotid endarterectomy showed a 15% restenosis rate over 5 years, with no symptomatic cases. Contralateral progression occurred in 20% of patients, linked to neurological symptoms.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Long-term outcomes and complications following CEA require ongoing investigation.
Purpose of the Study:
- To evaluate the long-term rates of ipsilateral restenosis, contralateral progression, neurological symptoms, and mortality after CEA.
- To assess the impact of these factors on patient outcomes.
Main Methods:
- A follow-up study of 292 CEA operations in 256 patients.
- Utilized color-coded carotid Doppler imaging and oculoplethysmography for assessment.
- Employed life table analysis to report outcomes over 5 years.
Main Results:
- The 5-year ipsilateral restenosis rate was 15%, with no symptomatic cases or reoperations required.
- Contralateral progression (stenosis >50%) occurred in 20% of patients over 5 years, significantly associated with neurological symptoms (p=0.05).
- Late neurological symptoms (14% at 5 years) were linked to widespread vascular disease, not restenosis. The 5-year mortality rate was 12%, with 40% of deaths due to myocardial infarction.
Conclusions:
- CEA demonstrates acceptable long-term safety, with restenosis rarely causing symptoms.
- Contralateral progression is a significant concern, potentially leading to neurological events.
- Noninvasive tests are crucial for monitoring post-CEA patients, especially for contralateral progression.
Abstract:
This study follows up 292 carotid endarterectomy operations in 256 patients using the colour coded carotid Doppler Imager and oculoplethysmography and reports the rate of ipsilateral restenosis, contralateral progression, late (after 30 days postoperatively) neurological symptoms and mortality in life table form. The restenosis rate was 15% at 5 years. No case of restenosis presented with symptoms and none required reoperation. The contralateral progression rate from less than 50% internal carotid artery stenosis to greater than 50% was 20% over 5 years. Significantly more symptoms were associated with cases of contralateral progression (p = 0.05). The late neurological symptom rate was 14% at 5 years and was associated with widespread intra/extracranial vascular disease rather than restenosis. The late death rate was 12% at 5 years of which 40% were due to myocardial infarction. The overall postoperative death rate over 5 years was the same as an age and sex matched population. A more aggressive approach to coronary artery disease does not appear justified. The value of noninvasive tests in the post-endarterectomy situation is stressed with particular reference to documentation of contralateral progression.