SECONDARY RECURRENT CAROTID STENOSIS

Purpose: Recurrent carotid stenosis after carotid endarterectomy has b een extensively reported. The occurrence, however, of another ipsilate ral restenosis that requires a third carotid operation is rare. The pu rpose of this study was to evaluate possible risk factors and the most efficacious management of the patient with ''secondary'' recurrent ca rotid stenosis. Methods: A survey of the Southern Association for Vasc ular Surgery was performed, and 31 patients who had had surgery for se condary recurrent carotid stenosis were identified. Results: The mean interval between the recurrent stenosis operation and secondary recurr ent carotid stenosis was 39.8 months (range, 9 to 83 months). At the t hird operation, 21 patients underwent carotid patch angioplasty and 10 underwent carotid resection with an interposition saphenous vein graf t. No postoperative strokes or deaths occurred; three patients (10%) h ad a peripheral nerve injury. Nine early (<24 mo) secondary recurrent carotid stenoses occurred, and these patients underwent patch angiopla sty. Twenty-three female, cigarette-smoking patients and 20 patients w ith elevated lipid levels had early restenosis and were identified as being at high risk for the development of another stenosis. A fourth s ignificant stenosis developed in five of these high-risk patients who had saphenous vein patch angioplasty at their third carotid operation; eight other high-risk patients had carotid resection with an interpos ition saphenous vein graft, and no other stenosis developed. Conclusio n: Patients who have secondary recurrent carotid stenoses can safely u ndergo a third carotid operation. Female habitual smokers with elevate d lipid levels and an early restenosis appear to be at high risk of se condary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more dur able than patch angioplasty.