TREATMENT OF RECURRENT CEREBROVASCULAR-DISEASE - REVIEW OF A 1O-YEAR EXPERIENCE

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.