BACKGROUND AND PURPOSE: We sought to determine the incidence of recurrent stenosis after carotid endarterectomy. METHODS: One thousand consecutive carotid endarterectomy patients were followed prospectively. The surgery was performed in a standard fashion. Cerebral protection was provided with intraoperative electroencephalographic monitoring and selective shunting. All arteriotomies were repaired with a patch graft. Each patient was seen 3 months after surgery and then yearly, with a duplex ultrasound obtained at each visit. Evidence for new ischemic events or recurrent stenosis of >or=70% was recorded. RESULTS: The 30-day combined minor and major stroke and death rate was 1.9%. At 7.1-year follow-up, 0.1% of patients had recurrent stenosis >or=70%, the majority of which were asymptomatic. CONCLUSIONS: Carotid endarterectomy is a low-risk procedure for the treatment of carotid occlusive disease, with excellent long-term durability. Although less invasive, carotid angioplasty must demonstrate equal robustness in long-term follow-up before it is considered a routine alternative to surgery.
BACKGROUND AND PURPOSE: We sought to determine the incidence of recurrent stenosis after carotid endarterectomy. METHODS: One thousand consecutive carotid endarterectomy patients were followed prospectively. The surgery was performed in a standard fashion. Cerebral protection was provided with intraoperative electroencephalographic monitoring and selective shunting. All arteriotomies were repaired with a patch graft. Each patient was seen 3 months after surgery and then yearly, with a duplex ultrasound obtained at each visit. Evidence for new ischemic events or recurrent stenosis of >or=70% was recorded. RESULTS: The 30-day combined minor and major stroke and death rate was 1.9%. At 7.1-year follow-up, 0.1% of patients had recurrent stenosis >or=70%, the majority of which were asymptomatic. CONCLUSIONS: Carotid endarterectomy is a low-risk procedure for the treatment of carotid occlusive disease, with excellent long-term durability. Although less invasive, carotid angioplasty must demonstrate equal robustness in long-term follow-up before it is considered a routine alternative to surgery.
Authors: Glenn M LaMuraglia; David C Brewster; Ashby C Moncure; David J Dorer; Michael C Stoner; Samir K Trehan; Elizabeth C Drummond; William M Abbott; Richard P Cambria Journal: Ann Surg Date: 2004-09 Impact factor: 12.969