TREATMENT OF RECURRENT CAROTID DISEASE - REPORT ON A 12-YEAR EXPERIENCE

The purpose of this study was to determine whether repeat carotid enda rterectomy (CEA) poses a greater risk than first-time CEA. The authors analyzed data from 893 consecutive CEA cases (1981-1993). Thirty-thre e patients (3.7%) had repeat CEA, and 860 (96.3%) had first-time CEA. There were statistically significantly higher incidences of hypertensi on (60.6% vs 44.6%), smoking (84.8% vs 55%), hypertriglyceridemia (33. 3% vs 16.2%), and coronary artery disease (66.6% vs 36%) in the repeat CEA group than in the first-time CEA group. Symptomatic disease was p resent in 25 (75.8%) patients in the repeat group and in 576 (67%) pat ients in the first-time group (P>0.05). The cause of recurrence was at herosclerosis in 25 patients (76%), myointimal hyperplasia in seven pa tients (21.2%), and intraluminal thrombus without an underlying lesion in one patient (3%). Redo CEA with vein patch angioplasty was perform ed in 27 patients (82%), vein patch angioplasty alone in five patients (15%), and interposition vein graft in one patient (3%). The hospital operative mortality was 0% (n=0) in the repeat CEA group and 0.6% (n= 5) in the first-time CEA group (P > 0.05). The incidence of postoperat ive stroke was 0% (n=0) in the repeat group and 1.2% (n=10) in the fir st-time group (P>0.05). There was one case (3%) of transient ischemic attack (TIA) in the repeat group, and two cases (0.2%) of TIA in the f irst-time group. There was no difference in the incidence of cranial n erve dysfunction between the repeat group (n=2, 6%) and the first-time group (n=41 4.8%; P>0.05). Late follow-up data were obtained for 30 p atients (mean: 61.4 months, range: 5-158 months) in the repeat CEA gro up and 501 patients (mean: 55.8 months, range: 17-168 months) in the f irst-time CEA group, The incidence of late failure (ipsilateral stroke or TIA) was 3.3% (n=1) in the repeat group and 3.2% (n=16) in the fir st-time CEA group; P>0.05. The overall late mortality was 20% (n=6) in the repeat CEA group and 14.6% (n=73) in the primary CEA group; P>0.0 5. Repeat CEA can be performed safely in individuals with severe recur rent carotid stenosis, and perioperative and long-term mortality and n eurologic morbidity rates are similar to those for patients undergoing first-time carotid endarterectomy.