Redo surgery for carotid artery stenosis: when and how?

Purpose: We analyzed operations performed at our institution retrospectivel y for recurrent carotid artery stenosis to assess the indication for surger y. We also assessed the techniques used for these operations. Patients and methods: From January 1992 to December 1998 1210 carotid endar terectomies were performed. Forty two (3.4%) of these were for recurrent st enosis, A new vein patch was implanted in 27 cases, PTFE patches were used in nine cases. In six cases an interposition with the great saphenous vein was performed. Results: The mean interval between primary and secondary procedure was 60.2 months (3 months to 23 yr), Twenty five of our 41 patients had had ipsilat eral neurologic symptoms before redo surgery, the remainder were free of sy mptoms. The grade of stenosis was over 90% in 22 cases, between 75 and 90% in 11 cases and below 75% in nine cases, two cases had aneurysmatic lesions , None of the patients died in the 30 day observation period. One patient h ad a stroke with a permanent neurological deficit. In two cases postoperati ve bleeding occurred requiring reexploration, Two patients developed hypogl ossal neurapraxia and in four patients the recurrent laryngeal nerve was in jured. One patient had an apnoic episode in the recovery room. Conclusion: The reported incidence of recurrent carotid artery stenosis sur gery ranges from 3 to 36% and our incidence is at the lower end of this ran ge. The surgical results of reoperating are acceptable with a low incidence of complications. (C) 2000 The International Society for Cardiovascular Su rgery, Published by Elsevier Science Ltd. All rights reserved.