Recurrent carotid stenosis after carotid endarterectomy

This review examines the history, incidence, aetiology and pathology of recurrent carotid stenosis, and assesses the methods and results of managing patients with this condition.

Over 200 references were retrieved from Medline from 1966 to 1996. Data were collected which reported the incidence, timing, method of diagnosis, follow-up, percentage of patients with symptoms and the indications for revisional surgery. The stroke rate and operative mortality rate following revisional carotid surgery were also recorded.

The overall incidence of symptomatic recurrent stenosis ranged from 0 to 8.2 per cent, with a symptomless recurrence rate between 1.3 and 37 per cent. Forty-three (78 per cent) of 55 studies indicated that revisional surgery was performed on patients with symptoms; only 21 (38 per cent) of 55 studies indicated that operations were carried out on asymptomatic patients. The stroke rate and mortality rate after 511 revisional procedures were 3.9 and 1.0 per cent respectively.

Symptomatic recurrent stenosis is rare but some patients may benefit from revisional surgery. Surgery for symptomless carotid restenosis should be considered only if a multicentre trial can demonstrate clear benefit in terms of patient survival or stroke reduction.