The Long-Term Effectiveness of Carotid Endarterectomy in Prevention of Strokes

Edwards, W. Sterling; Wilson, Taylor; Bennett, Ari J.

doi:10.1097/00000658-196810000-00020

Cited by 49 publications

(7 citation statements)

References 2 publications

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“…After 5 years, arteriographic followup was available in 15 patients, with a 13% incidence of recurrent stenosis. Edwards et al 7 reported arteriographic correlation in 30 patients (43 carotid endarterectomies) 5 or more years after carotid endarterectomy; 3 patients had significant restenosis and 6 had stenoses of <25%, yielding a 21% incidence of recurrent disease. Schutz et al 8 reported angiographic evaluation following 59 carotid endarterectomies; 6 of the 59 (10%) were occluded.…”

Section: Discussionmentioning

confidence: 99%

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

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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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.

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Section: Discussionmentioning

confidence: 99%

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

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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“…Our incidence of symptomatic recurrence is 4.5%, while others report between 1% and 7%. [3][4][5][6][7][8][9] The cause of restenosis is not completely understood. Technical errors at the time of the original operation were thought to be the cause of restenosis in six of our 21 patients.…”

Section: Resultsmentioning

confidence: 99%

Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Cantelmo¹

1981

Arch Surg

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“…Previous reports regarding the incidence of recurrent disease or stenosis of the ICA following endarterectomy have varied widely with values from 1 to 28 % (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). This variation not only reflects the method of diagnosis, but presumably also the expertise of the neurosurgical team.…”

Section: Discussionmentioning

confidence: 99%

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies two years after endarterectomy

Russell¹,

Bakke²,

Wiberg³

et al. 2009

Acta Neurologica Scandinavica

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A follow‐up of 55 patients 2 years after a total of 60 carotid endarterec‐tomies. Fifty‐two patients who had a total of 57 endarterectomies survived the first 2 post‐operative years and were re‐examined using pulsed Doppler spectral analysis and intravenous digital subtraction angiography (IVDSA). One patient had died following a stroke and 2 after a cardiac infarction. The Doppler and IVDSA examinations revealed a non‐symptomatic re‐stenosis of the relevant internal carotid artery in 2 patients. There were no relevant occlusions and no symptomatic re‐stenoses were detected. Spectral spreading of the Doppler signal at the site of the endarterectomy was found in 18% of the internal carotid arteries, whereas wall irregularities (diameter reduction less than 10%) were demonstrated in 25% by IVDSA. A stenosis or occlusion was found in 14 (25%) of the 57 ipsilateral external carotid arteries.

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The Long-Term Effectiveness of Carotid Endarterectomy in Prevention of Strokes

Cited by 49 publications

References 2 publications

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

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

Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Patency and flow velocity profiles in the internal carotid artery assessed by digital subtraction angiography and Doppler studies two years after endarterectomy

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