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. 1986 Feb;203(2):205–213. doi: 10.1097/00000658-198602000-00015

Recurrent carotid stenosis. Results and complications of 57 operations.

D G Piepgras, T M Sundt Jr, W R Marsh, L A Mussman, N C Fode
PMCID: PMC1251070  PMID: 3947157

Abstract

Among 1992 patients undergoing carotid endarterectomy from January 1972 through December 1984, 57 operations were performed in 51 patients for recurrent carotid stenosis. Thirty-four of these cases had undergone initial surgery at this institution while 23 had endarterectomy elsewhere. Fifty-two of the 57 operations were for symptomatic disease while five were for evidence of a progressing lesion. All operative procedures were monitored with intracerebral blood flow measurements and continuous electroencephalograms. Twenty-three patients required intraoperative shunting. There were no complications related to shunt usage or to the period of temporary occlusion in patients who did not require shunting. Recurrent stenosis was related to intimal hyperplasia in 14 cases, recurrent atherosclerosis with interluminal thrombi or degenerated plaque in 27, unexplained soft thrombus in eight, proximal scarring in six, and to aneurysms in two. Intimal hyperplasia was the most common cause for restenosis within 2 years from the date of surgery and developed earlier in patients with a primary closure than in patients closed with a patch graft. The operative complication rate was 10.5% or 4 times the risk of surgery for primary atherosclerosis at this institution. Complications were attributed primarily to intraoperative and postoperative thromboembolic events related to apparent increased thrombogenicity of these vessels. The highest complication rate occurred in the group of patients undergoing surgery for thrombotic material in the internal carotid artery, either primary or with underlying atherosclerosis. There were no neurological complications in the group with myointimal hyperplasia. The authors' experience suggests that on-lay patch grafting without endarterectomy should be used in patients with myointimal hyperplasia. Patients with complicated recurrent atherosclerosis can be treated with endarterectomy and patch grafting, but interposition vein grafts should be considered in cases in which the vessels are extensively damaged by the recurrent plaque or with an unexplained thrombus at the site of previous endarterectomy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker W. H., Hayes A. C., Mahler D., Littooy F. N. Durability of carotid endarterectomy. Surgery. 1983 Jul;94(1):112–115. [PubMed] [Google Scholar]
  2. Bodily K. C., Zierler R. E., Marinelli M. R., Thiele B. L., Greene F. M., Jr, Strandness D. E., Jr Flow disturbances following carotid endarterectomy. Surg Gynecol Obstet. 1980 Jul;151(1):77–80. [PubMed] [Google Scholar]
  3. Callow A. D. The Leriche Memorial Lecture. Fact or fancy: a twenty year personal perspective on the detection and management of carotid occlusive disease. J Cardiovasc Surg (Torino) 1980 Nov-Dec;21(6):641–658. [PubMed] [Google Scholar]
  4. Cantelmo N. L., Cutler B. S., Wheeler H. B., Herrmann J. B., Cardullo P. A. Noninvasive detection of carotid stenosis following endarterectomy. Arch Surg. 1981 Aug;116(8):1005–1008. doi: 10.1001/archsurg.1981.01380200019003. [DOI] [PubMed] [Google Scholar]
  5. Cossman D., Callow A. D., Stein A., Matsumoto G. Early restenosis after carotid endarterectomy. Arch Surg. 1978 Mar;113(3):275–278. doi: 10.1001/archsurg.1978.01370150047008. [DOI] [PubMed] [Google Scholar]
  6. DEBAKEY M. E., CRAWFORD E. S., COOLEY D. A., MORRIS G. C., Jr, GARRET H. E., FIELDS W. S. CEREBRAL ARTERIAL INSUFFICIENCY: ONE TO 11-YEAR RESULTS FOLLOWING ARTERIAL RECONSTRUCTIVE OPERATION. Ann Surg. 1965 Jun;161:921–945. doi: 10.1097/00000658-196506000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Das M. B., Hertzer N. R., Ratliff N. B., O'Hara P. J., Beven E. G. Recurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg. 1985 Jul;202(1):28–35. doi: 10.1097/00000658-198507000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DeWeese J. A., Rob C. G., Satran R., Marsh D. O., Joynt R. J., Summers D., Nichols C. Results of carotid endarterectomies for transient ischemic attacks-five years later. Ann Surg. 1973 Sep;178(3):258–264. doi: 10.1097/00000658-197309000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Deriu G. P., Ballotta E., Bonavina L., Grego F., Alvino S., Franceschi L., Meneghetti G., Saia A. The rationale for patch-graft angioplasty after carotid endarterectomy: early and long-term follow-up. Stroke. 1984 Nov-Dec;15(6):972–979. doi: 10.1161/01.str.15.6.972. [DOI] [PubMed] [Google Scholar]
  10. Diaz F. G., Patel S., Boulos R., Mehta B., Ausman J. I. Early angiographic changes after carotid endarterectomy. Neurosurgery. 1982 Feb;10(2):151–161. [PubMed] [Google Scholar]
  11. French B. N., Rewcastle N. B. Recurrent stenosis at site of carotid endarterectomy. Stroke. 1977 Sep-Oct;8(5):597–605. doi: 10.1161/01.str.8.5.597. [DOI] [PubMed] [Google Scholar]
  12. Goldstone J., Moore W. S. Emergency carotid artery surgery in neurologically unstable patients. Arch Surg. 1976 Nov;111(11):1284–1291. doi: 10.1001/archsurg.1976.01360290118018. [DOI] [PubMed] [Google Scholar]
  13. Hertzer N. R., Beven E. G., Modic M. T., O'Hara P. J., Vogt D. P., Weinstein M. A. Early patency of the carotid artery after endarterectomy: digital subtraction angiography after two hundred sixty-two operations. Surgery. 1982 Dec;92(6):1049–1057. [PubMed] [Google Scholar]
  14. Hertzer N. R., Martinez B. D., Benjamin S. P., Beven E. G. Recurrent stenosis after carotid endarterectomy. Surg Gynecol Obstet. 1979 Sep;149(3):360–364. [PubMed] [Google Scholar]
  15. Kremen J. E., Gee W., Kaupp H. A., McDonald K. M. Restenosis or occlusion after carotid endarterectomy: a survey with ocular pneumoplethysmography. Arch Surg. 1979 May;114(5):608–610. doi: 10.1001/archsurg.1979.01370290058011. [DOI] [PubMed] [Google Scholar]
  16. Little J. R., Bryerton B. S., Furlan A. J. Saphenous vein patch grafts in carotid endarterectomy. J Neurosurg. 1984 Oct;61(4):743–747. doi: 10.3171/jns.1984.61.4.0743. [DOI] [PubMed] [Google Scholar]
  17. Murphey F., Maccubbin D. A. Carotid endarterectomy. A long-term follow-up study. J Neurosurg. 1965 Aug;23(2):156–168. doi: 10.3171/jns.1965.23.2.0156. [DOI] [PubMed] [Google Scholar]
  18. Norrving B., Nilsson B., Olsson J. E. Progression of carotid disease after endarterectomy: a Doppler ultrasound study. Ann Neurol. 1982 Dec;12(6):548–552. doi: 10.1002/ana.410120608. [DOI] [PubMed] [Google Scholar]
  19. Riles T. S., Imparato A. M., Mintzer R., Baumann F. G. Comparison of results of bilateral and unilateral carotid endarterectomy five years after surgery. Surgery. 1982 Mar;91(3):258–262. [PubMed] [Google Scholar]
  20. Stoney R. J., String S. T. Recurrent carotid stenosis. Surgery. 1976 Dec;80(6):705–710. [PubMed] [Google Scholar]
  21. Sundt T. M., Jr, Houser O. W., Fode N. C., Whisnant J. P. Correlation of postoperative and two-year follow-up angiography with neurological function in 99 carotid endarterectomies in 86 consecutive patients. Ann Surg. 1986 Jan;203(1):90–100. doi: 10.1097/00000658-198601000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sundt T. M., Jr, Sharbrough F. W., Piepgras D. G., Kearns T. P., Messick J. M., Jr, O'Fallon W. M. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc. 1981 Sep;56(9):533–543. [PubMed] [Google Scholar]
  23. Thompson J. E., Austin D. J., Patman R. D. Carotid endarterectomy for cerebrovascular insufficiency: long-term results in 592 patients followed up to thirteen years. Ann Surg. 1970 Oct;172(4):663–679. doi: 10.1097/00000658-197010000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Turnipseed W. D., Berkoff H. A., Crummy A. Postoperative occlusion after carotid endarterectomy. Arch Surg. 1980 May;115(5):573–574. doi: 10.1001/archsurg.1980.01380050005002. [DOI] [PubMed] [Google Scholar]
  25. Yashon D., Jane J. A., Javid H. Long term results of carotid bifurcation endarterectomy. Surg Gynecol Obstet. 1966 Mar;122(3):517–523. [PubMed] [Google Scholar]

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