SIGNIFICANCE OF CAROTID RESTENOSIS FOLLOWING ENDARTERECTOMY

Background and Purpose: The clinical significance of restenosis after carotid endarterectomy as detected by duplex ultrasound has not: been clearly established. To address this problem, we retrospectively evalu ated the experience at two university-affiliated hospitals. Methods: A ll charts of patients with carotid endarterectomies between June 1987 and April 1995 were reviewed. Inclusion required neurological assessme nt and postoperative duplex ultrasound. Exclusion was based on a known source of cardioembolic disease, or recent (<6 months) myocardial inf arction. Primary clinical endpoints were ipsilateral transient ischemi c attack (TIA) or ischemic stroke, Contributing vascular risk factors were also identified. The effect of restenosis on event-free survival was analyzed using life tables and Gehan-Wilcoxon rank sum tet, Logist ic regression was used to identify independent risk factors for resten osis and vascular events. Results: One hundred and eighty-seven patien ts were identified who underwent a total of 207 endarterectomies. Mean follow-up was 30.4 +/- 20.9 months during which a total of 64 vascula r events, including 42 TIAs, 18 strokes, and 4 vascular deaths occurre d, Of these 21 TIAs and 8 strokes were ipsilateral to the side of enda rterectomy, Event rates were compared for patients with ipsilateral hi gh- (greater than or equal to 50%) and low-grade (<50%) restenosis, Th ese two groups were comparable in terms of baseline risk factors. Ther e was no significant difference in vascular event rates (for either ip silateral events or events in any vascular territory) between the grou p with high- and low-grade restenosis. Nor was any such difference in event rates shown for patients who showed ipsilateral progression of c arotid disease on serial ultrasound. However, patients operated for sy mptomatic carotid disease had a significantly higher risk of neurologi cal events (p = 0.035). Logistic regression failed to disclose any oth er risk factors that were independently predictive of either restenosi s or vascular events during follow-up. Conclusion: This study does not show a difference in vascular event rates for higher grades of caroti d restenosis after carotid endarterectomy, Routine surveillance with c arotid ultrasound does not appear to identify patients at higher risk for postoperative cerebrovascular events.