REOPERATION FOR RECURRENT CAROTID STENOSIS - A 10-YEAR EXPERIENCE

Owing to the supposed risks of reoperation, carotid stenting has been proposed as a treatment for carotid restenosis. The purpose of this st udy is to determine the safety and efficacy of carotid reoperation. Fr om March 1988 to March 1997, 40 patients, 18 men and 22 women (mean ag e: 65 years) underwent a total of 43 redo carotid procedures by our gr oup. Two patients had both sides repaired and one required a second re operation. Symptomatic recurrent carotid stenosis (>70%) was the indic ation in 25 reoperations and asymptomatic high-grade stenosis (>80%) w as the indication in 18. The initial operation in 35 reoperations was carotid endarterectomy (CEA) with primary closure and in eight it was CEA with a prosthetic patch. The interval to recurrence was less in th e 24 reoperations in patients who had myointimal hyperplasia (21 month s) compared with 17 reoperations in patients with recurrent atheroscle rosis (90 months). The other two reoperations were for an intimal flap 2 months after the original CEA, and for operative dilation of fibrom uscular dysplastic bands missed on magnetic resonance angiography (MRA ), distal to the site of a previous CEA. The technique of reoperation included redo CEA in two, CEA with vein patch in eight, CEA with prost hetic patch in 22, vein interposition graft in five, and prosthetic in terposition graft in five. In addition, operative dilation with an art erial dilator was used in one reoperation. No perioperative strokes or deaths occurred other than one patient who died from cardiac complica tions following combined CEA and coronary artery bypass grafting. Oper ative morbidity consisted of pneumonia in one patient, reversible cran ial nerve injury in four, and hematoma requiring evacuation in two. Du ring follow-up (mean: 34 months), carotid occlusion resulted in a mild stroke in one patient, there were 10 late deaths not related to carot id disease, one patient required a reoperation, and three patients wer e lost to follow-up. The authors conclude that reoperation for recurre nt carotid stenosis, using standard vascular techniques, is both safe and effective; it should continue to be the mainstay of treatment when intervention is required.