BACKGROUND: The role of carotid surgery for the management of restenosis after carotid endarterectomy (CEA) is challenged by carotid artery stenting (CAS). We reviewed redo CEA in a consecutive series of patients to determine the safety, durability, and long-term benefit associated with repeat surgical treatment for restenosis. METHODS: A consecutive series of 73 redo procedures in 72 patients (57% men) with a mean age 66 years (range, 49-81 years) was analyzed. The mean interval between prior CEA and redo CEA was 53 months (range, 8-192 months). Operative indications included symptomatic restenosis in 28 patients (38%). A patch angioplasty was performed in 62 patients (85%). The main outcome measures included perioperative and late stroke and death, and the development of secondary restenosis. RESULTS: There were no perioperative deaths or strokes. During a mean follow-up of 52 months (range, 12-144 months), the Kaplan-Meier cumulative survival was 85% at 5 years. At 5 years, the cumulative rate of freedom from all strokes was 98%, and the freedom from ipsilateral stroke was 100%. After secondary procedures, re-recurrent stenosis > or =50% occurred in 10 patients (13.7%). The cumulative freedom from re-restenosis (> or =50%) was 85% at 5 years. Five patients (7%) received tertiary carotid reconstructions. CONCLUSION: Repeat CEA for recurrent stenosis can be performed safely with excellent long-term protection from stroke. These data provide a standard against which the results of CAS can be compared.
BACKGROUND: The role of carotid surgery for the management of restenosis after carotid endarterectomy (CEA) is challenged by carotid artery stenting (CAS). We reviewed redo CEA in a consecutive series of patients to determine the safety, durability, and long-term benefit associated with repeat surgical treatment for restenosis. METHODS: A consecutive series of 73 redo procedures in 72 patients (57% men) with a mean age 66 years (range, 49-81 years) was analyzed. The mean interval between prior CEA and redo CEA was 53 months (range, 8-192 months). Operative indications included symptomatic restenosis in 28 patients (38%). A patch angioplasty was performed in 62 patients (85%). The main outcome measures included perioperative and late stroke and death, and the development of secondary restenosis. RESULTS: There were no perioperative deaths or strokes. During a mean follow-up of 52 months (range, 12-144 months), the Kaplan-Meier cumulative survival was 85% at 5 years. At 5 years, the cumulative rate of freedom from all strokes was 98%, and the freedom from ipsilateral stroke was 100%. After secondary procedures, re-recurrent stenosis > or =50% occurred in 10 patients (13.7%). The cumulative freedom from re-restenosis (> or =50%) was 85% at 5 years. Five patients (7%) received tertiary carotid reconstructions. CONCLUSION: Repeat CEA for recurrent stenosis can be performed safely with excellent long-term protection from stroke. These data provide a standard against which the results of CAS can be compared.
Authors: Isibor J. Arhuidese; Muhammad Faateh; Besma J. Nejim; Satinderjit Locham; Christopher J. Abularrage; Mahmoud B. Malas Journal: JAMA Surg Date: 2018-03-01 Impact factor: 14.766
Authors: Margriet Fokkema; Rodney P Bensley; Ruby C Lo; Allan D Hamden; Mark C Wyers; Frans L Moll; Gert Jan de Borst; Marc L Schermerhorn Journal: J Vasc Surg Date: 2013-02-04 Impact factor: 4.268
Authors: Margriet Fokkema; Gert Jan de Borst; Brian W Nolan; Ruby C Lo; Robert A Cambria; Richard J Powell; Frans L Moll; Marc L Schermerhorn Journal: J Vasc Surg Date: 2013-08-22 Impact factor: 4.268