RECURRENT CAROTID STENOSIS AFTER CAROTID ENDARTERECTOMY

Background 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. Methods Over 200 ref erences were retrieved from Medline from 1966 to 1996, Data were colle cted which reported the incidence, timing, method of diagnosis, follow -up, percentage of patients with symptoms and the indications for revi sional surgery. The stroke rate and operative mortality rate following revisional carotid surgery were also recorded. Results The overall in cidence of symptomatic recurrent stenosis ranged from 0 to 8.2 per cen t, with a symptomless recurrence rate between 1.3 and 37 per cent, For ty-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 pat ients. The stroke rate and mortality rate after 511 revisional procedu res were 3.9 and 1.0 per cent respectively. Conclusion Symptomatic rec urrent stenosis is rare but some patients may benefit from revisional surgery. Surgery for symptomless carotid restenosis should be consider ed only if a multicentre trial can demonstrate clear benefit in terms of patient survival or stroke reduction.