Late stroke after carotid endarterectomy: The role of recurrent stenosis

Washburn, W.Kenneth; Mackey, William C.; Belkin, Michael; O’Donnell, Thomas F.

doi:10.1016/0741-5214(92)90460-p

Cited by 40 publications

(16 citation statements)

References 15 publications

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“…Others also advocate a nonoperative approach to patients with asymptomatic recurrent carotid stenosis. 22,23 In contrast, O'Donnell et al 24 concluded that there was a higher incidence of unheralded strokes (7.5%) in patients with recurrent stenosis who did not undergo operation, and they believed that a more aggressive approach might be warranted in patients with asymptomatic high-grade stenoses (Ͼ75%). O'Donnell et al 24 also indicated that most of the studies that recommended nonoperative therapy for recurrent stenosis failed to discriminate between high-grade (Ͼ80%) and moderate (50% to 80%) recurrent carotid stenoses.…”

Section: Discussionmentioning

confidence: 95%

Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

AbuRahma

Jennings

Wulu

et al. 2001

Stroke

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Background and Purpose-Several authorities have recently advocated carotid stenting for recurrent carotid stenosis because of the perception that redo surgery has a higher complication rate than primary carotid endarterectomy (CEA). This study compares the early and late results of reoperations versus primary CEA. Methods-All reoperations for recurrent carotid stenosis performed during a recent 7-year period by a single vascular surgeon were compared with primary CEA. Because all redo CEAs were done with polytetrafluoroethylene (PTFE) or vein patch closure, we only analyzed those primary CEAs that used the same patch closures. A Kaplan-Meier life-table analysis was used to estimate stroke-free survival rates and freedom from Ն50% recurrent stenosis. Results-Of 547 primary CEAs, 265 had PTFE or saphenous vein patch closure, and 124 reoperations had PTFE or vein patch closure during the same period. Both groups had similar demographic characteristics. The indications for reoperation and primary CEA were symptomatic stenosis in 78% and 58% of cases and asymptomatic Ն80% stenosis in 22% and 42% of cases, respectively (PϽ0.001). The 30-day perioperative stroke and transient ischemic attack rates for reoperation and primary CEA were 4.8% versus 0.8% (Pϭ0.015) and 4% versus 1.1%, respectively, with no perioperative deaths in either group. Cranial nerve injury was noted in 17% of reoperation patients versus 5.3% of primary CEA patients; however, most of these injuries were transient (PϽ0.001). Mean hospital stay was 1.8 days for reoperation versus 1.6 days for primary CEA. Cumulative rates of stroke-free survival and freedom from Ն50% recurrent stenosis for reoperation and primary CEA at 1, 3, and 5 years were 96%, 91%, and 82% and 98%, 96%, and 95% versus 94%, 92%, and 91% and 98%, 96%, and 96%, respectively (no significant differences). Conclusions-Reoperation carries higher perioperative stroke and cranial nerve injury rates than primary CEA. However, reoperations are durable and have stroke-free survival rates that are similar to primary CEA. These considerations should be kept in mind when carotid stenting is recommended instead of reoperation.

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Section: Discussionmentioning

confidence: 95%

Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

AbuRahma

Jennings

Wulu

et al. 2001

Stroke

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“…While it is generally agreed upon by most experts that reoperation for significant symptomatic post-CEA stenosis is indicated, there is some controversy regarding the indications for reoperation for asymptomatic restenosis. [7][8][9] This is largely due to the inherent risks in any open reintervention in a previously operated field, such as increased scar tissue, which can obscure tissue planes and make identification of anatomic structures and surgical landmarks more challenging. Reoperation can have morbidity and mortality rates as high as 8% to 20%, [13][14][15][16][17][18][19][20] although recent literature suggests that this is improving.…”

Section: Discussionmentioning

confidence: 99%

Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for patients with post-carotid endarterectomy stenosis

AbuRahma

Abu-Halimah

Hass

et al. 2010

Journal of Vascular Surgery

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“…6,[21][22][23][24][25] However, there is also evidence to the contrary, which supports the hypothesis that recurrent carotid disease is causally related to late ipsilateral stroke after carotid endarterectomy. [26][27][28] The arguments for the nonoperative management of recurrent carotid stenoses are on the basis of the presumed increased risk for perioperative complications that exists with redo cases. An additional rationale for the nonoperative management of early recurrent stenoses, in particular, is on the basis of the hypothesis that the lesions of neointimal hyperplasia simply do not carry the same embolic potential as atherosclerotic lesions.…”

Section: Discussionmentioning

confidence: 99%

Redo carotid surgery: An analysis of materials and configurations used in carotid reoperations and their influence on perioperative stroke and subsequent recurrent stenosis

Rockman

Riles

Landis

et al. 1999

Journal of Vascular Surgery

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The use of autologous material for redo carotid surgery in any configuration appears to significantly increase the rate of subsequent recurrent stenosis or total occlusion of the operated artery. The reason for this finding is unclear but may be related to both host and technical factors. Prosthetic material may be more durable in the long-term for redo carotid surgery. Interposition grafting for redo carotid surgery may increase the perioperative neurologic complication rate to some degree; however, this was not statistically significant in this series. Interposition grafting may be a more durable solution in long-term follow-up than redo endarterectomy and patch angioplasty. A longer follow-up period will be needed to confirm this conclusion.

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Late stroke after carotid endarterectomy: The role of recurrent stenosis

Cited by 40 publications

References 15 publications

Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for patients with post-carotid endarterectomy stenosis

Redo carotid surgery: An analysis of materials and configurations used in carotid reoperations and their influence on perioperative stroke and subsequent recurrent stenosis

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