Related Experiment Videos
Carotid endarterectomy. Relationship of outcome to early restenosis
Insights
Carotid endarterectomy shows low perioperative stroke and mortality rates. Restenosis is common, especially in women, but reoperation is not recommended to prevent future strokes.
Area of Science:
- Vascular Surgery
- Neurology
- Medical Imaging
Background:
- Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries.
- Evaluating long-term outcomes and restenosis rates is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate the long-term results of carotid endarterectomy.
- To assess the incidence and impact of restenosis on clinical outcomes.
Main Methods:
- Prospective evaluation of 134 patients (145 sides) over 4 years.
- Utilized repeat ultrasonic duplex scanning and clinical assessments.
- Life-table analysis was employed to determine restenosis rates.
Main Results:
- Low perioperative stroke (1.3%) and mortality (0.7%) rates.
- 22% of patients developed recurrent high-grade stenosis, significantly more in women.
- No consistent association found between restenosis and symptom development.
Conclusions:
- Carotid endarterectomy is associated with favorable short-term outcomes.
- Restenosis is a frequent complication, particularly in female patients.
- Reoperation is not indicated solely based on stenosis degree to prevent future transient ischemic attacks (TIAs) or strokes.
Abstract:
The results following carotid endarterectomy were prospectively evaluated in 134 patients (145 sides) by repeat ultrasonic duplex scanning and clinical evaluation extending for a period of 4 years. There were 107 men and 27 women in the study group. The perioperative stroke rate was 1.3% and the mortality rate, 0.7%. There were 9 late deaths, of which two were stroke related (1.4%). Focal symptoms occurred in 12 patients on the ipsilateral side, six of which were strokes (one lacunar). The remaining symptoms developed in the presence of moderate degrees of carotid stenosis (less than 50%). There were seven patients who had transient ischemic attacks (TIAs) referable to the operated side, but only two of these were associated with a recurrent high-grade stenosis. During follow-up 32 (22%) patients had recurrent high-grade stenosis. Restenosis regressed in seven, giving a persistent rate of 17.1%. The incidence of restenosis was significantly higher in women (p less than 0.01). By life-table analysis, restenosis occurred early, the majority within 24 months. There was no consistent association between the development of symptoms and the occurrence of restenosis. Therefore, it is concluded that there is no justification for reoperation based on the degree of narrowing observed to prevent subsequent TIAs and strokes.