Objective The authors determined whether carotid endarterectomy in pat
ients with recurrent cerebrovascular disease poses a greater periopera
tive risk than for those individuals undergoing first-time carotid end
arterectomy. Summary Background Data A percentage of patients undergoi
ng carotid endarterectomy for atherosclerosis experience recurrent cer
ebrovascular disease. Reoperation may be difficult because of postoper
ative scarring of the soft tissues of the neck and the carotid artery
itself. Such patients were believed to be at greater risk for perioper
ative morbidity than those undergoing first-time carotid endarterectom
y. Methods To address this concern, the authors retrospectively review
ed their experience with 69 patients who underwent repeat carotid enda
rterectomies over a recent 10-year period of time. This subgroup repre
sented 6.4% of 1072 total carotid endarterectomies performed during th
e same time period. The average extent of stenosis on the operated sid
e was 81% and the time elapsed after previous endarterectomy averaged
83 months. Twelve patients (17.4%) had contralateral internal carotid
occlusion, and 30 patients (43.5%) had undergone previous endarterecto
mies on the contralateral side. Results Complications within 30 days o
f operation included two deaths (2.9%) and one stroke (1.4%), for a co
mbined stroke and death rate of 4.3%. Six patients developed cervical
hematomas requiring drainage; one of these had rupture of a saphenous
vein patch. No patient had a significant cranial nerve injury in the r
eoperative group, whereas 2.0% of patients undergoing first-time carot
id endarterectomy had cranial nerve injuries. Overall, these results c
ompared favorably with a combined stroke and death rate of 4.0% among
1003 patients who underwent first-time carotid endarterectomy during t
he same period. Conclusions This review suggests that repeat carotid e
ndarterectomy can be performed safely in individuals with severe recur
rent carotid stenosis, with morbidity and mortality rates similar to t
hose for patients undergoing first-time carotid endarterectomies. For
this population, reoperative carotid endarterectomy represents a safe
and important mechanism for the prevention of stroke.