Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

Abstract

Recurrent stenosis has not been a primary consideration in the selection of patients for carotid endarterectomy. We have studied the incidence of postoperative restenosis retrospectively in 265 patients following 310 carotid endarterectomies. Two hundred fourteen patients (248 endarterectomies) were examined at 6-12 month intervals using ocular pneumopiethysmography, spectral analysis, and B-mode imaging. The absolute incidence of recurrent carotid disease was 28% (69 of 248), with a 13% (33 of 248) incidence of hemodynamically significant restenosis and a 15% (36 of 248) incidence of hemodynamically insignificant disease. Life table analysis of the data projected a 32% incidence of hemodynamically significant restenosis after 7 years and a 40% incidence of hemodynamically insignificant recurrence. These data demonstrate a progressively increasing rate of restenosis. The incidence of ipsilateral neurologic events was 8% (24 of 310); 12 occurred in association with noninvasively evident recurrent disease (12 of 69, 17%), whereas 11 occurred in noninvasively determined normal arteries (11 of 179,6%). Noninvasive follow-up was not available in 1 patient. Of the 12 events associated with recurrent disease, 5 occurred in association with hemodynamically significant restenosis (5 of 33,15%), whereas 7 occurred in association with hemodynamically insignificant disease (7 of 36,19%). Carotid endarterectomy is a durable operative procedure with 92% (286 of 310) of arteries remaining asymptomatic over the period of clinical follow-up. However, absolute and life table projections of the incidence of asymptomatic restenosis are high, and this factor should be considered in the selection of patients for carotid endarterectomy, particularly in the absence of lateralizing symptoms. (Stroke 1987; 18:1031-1036) R ecurrent stenosis following carotid endarterectomy has been described previously.'-" The .. incidence of restenosis, however, remains variable, dependent on the methods of diagnosis and the inclusion of asymptomatic as well as symptomatic recurrence. Stoney and String 1 reported a 1.9% incidence of recurrent disease based on recurrent symptoms, whereas Nicholls et al 2 and O'Donnell and Callow 3 have documented recurrence rates of 12-22% based on the results of noninvasive diagnostic techniques. The implications of these data are significant and relevant to the determination of operative indications in symptomatic and asymptomatic patients.The technologic improvements in noninvasive diagnostic methods have provided safe and practical means of following patients after carotid endarterectomy. The purpose of this report is to determine the incidence of restenosis in patients undergoing carotid endarterectomy for symptomatic and asymptomatic lesions, using oculoplethysmography and ultrasonography. Data were assessed using life table analysis for a 5-7-year period of clinical follow-up.

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…Other observational studies or smaller clinical trials have reported variable rates of restenosis after CEA. [364][365][366][367][368][369] Imaging technique, length of follow-up, stenosis criterion, loss rates, and case mix undoubtedly contribute to these disparate findings. According to a recent narrative review, however, the rate of hemodynamically significant restenosis after CEA is probably 5% to 7% during variable periods of follow-up.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…407,440,468,624,625,628 -630 When periodic duplex scanning is used, hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials in which the quality of surgery is monitored carefully. 396,403,404,406,440,628,[631][632][633][634][635][636][637][638][639][640][641][642][643][644][645] Recurrent carotid stenosis after CEA is a trimodal phenomenon. The first event is not really recurrence but instead represents an unsatisfactory or incomplete CEA.…”

Stent Angioplasty for Cervical Carotid Artery Stenosis in High-Risk Symptomatic NASCET-Ineligible Patients

“…3 Although the majority (95.4%) of patients remained asymptomatic in the follow-up period, the risk of Ͼ60% restenosis or occlusion in the present study (5/20 patients, 25%) is higher than reported for the 3 to 18 months of follow-up of the 645 patients in the surgical arm of the Asymptomatic Carotid Atherosclerosis Study (ACAS) (7.6% to 11.4%) 22 and greater than the 6-to 12-month rate reported in other series (8%). 23 Since the original goal of the procedure was stroke prevention, the current management was effective in 4 of the 5 patients with Ͼ60% restenosis or occlusion for the limited length of follow-up. However, even if one were to consider only restenosis of Ͼ80% as clinically warranting retreatment, the rate in the present study remains significant at 15% (3/20 patients).…”