Clinical Outcomes of Restenosis Patients After Carotid Endarterectomy

To identify the clinical course of the patients with restenosis after carotid endarterectomy (CEA) based on treatment strategy and symptomatic status.

All consecutive patients who underwent CEA at a single tertiary referral center between 1994 and 2022 were enrolled. Patients were divided into 2 groups: subjects without restenosis and those with restenosis. The restenosis group was further subdivided based on treatment strategy into carotid artery stenting (CAS) or medical treatment alone. Primary outcome measures were the incidence of 5-year ipsilateral stroke, any stroke, and combined stroke/death post-restenosis.

Among a total of 1585 patients, 45 (2.8%) were diagnosed with restenosis after CEA; 6 (13%) were symptomatic, and 39 (87%) were asymptomatic. Notably, only one 5-year ipsilateral stroke occurred in the medical treatment alone subgroup. In the medical treatment alone subgroup, one patient with restenosis that occurred before 2002, when CAS was introduced was symptomatic. Regarding primary outcome measures, 11 cases of 5-year stroke and death occurred (11, 25%), and a greater number was observed in the medical treatment alone subgroup (n = 9) than in the CAS subgroup (n = 2) (10% vs. 37.5%, P = 0.036).

In asymptomatic patients with medical treatment alone subgroup, no cases of ipsilateral stroke were observed over a 5-year period, and the major cause of death were nonneurologic complications. Medical treatment may be a viable option for asymptomatic restenosis patients. Further research is needed to assess the necessity of reintervention in these cases.