SYMPTOMATIC RECURRENT CAROTID STENOSIS AND ANEURYSMAL DEGENERATION AFTER ENDARTERECTOMY

Background. Aneurysmal degeneration of a carotid reconstruction was no t recognized until the patient, who was known to have recurrent caroti d artery stenosis, had a thromboembolic stroke. This sequelae of carot id endarterectomy is a serious complication, associated with a high mo rbidity and mortality rate. This review was conducted to establish the risk of transient ischemic attack and stroke for patients found to ha ve recurrent carotid stenosis associated with aneurysmal degeneration of the carotid artery after endarterectomy. Methods. A case is reporte d, and 100 literature references of aneurysmal degeneration of the car otid artery after endarterectomy were reviewed. Results. False aneurys m anastomotic disruption was the most common presentation identified i n the cases reviewed. Nineteen of the patients had a significant neuro logic event; however, three (50%) Of six patients with aneurysm and re current carotid artery stenosis had a transient ischemic attack or str oke. Conclusions. The incidence of neurologic symptoms is markedly inc reased when recurrent carotid artery stenosis is associated with carot id aneurysm. During postoperative surveillance after endarterectomy, t he identification of recurrent carotid artery stenosis requires evalua tion for aneurysmal degeneration of the carotid artery with duplex sca nning. These patients are at significant risk for transient ischemic a ttack and stroke. This rare complication merits operative repair.