Abstract • The true incidence of recurrent carotid stenosis is unknown. Most reports provide only anecdotal data. Reported incidences, which range from 0.6% to 9.8%, reflect the care with which the search for recurrent stenosis was made by individual reporters. Early restenosis occurring within less than 24 months is characterized by a fibrous hyperplastic reaction, whereas stenoses occurring beyond this time are usually caused by typical atherosclerotic lesions. Although no clear risk factors can be identified, surgical trauma and inadequate endarterectomy are likely predisposing causes. Reoperation is technically more difficult and a patch graft, preferably vein, is often necessary. Careful postoperative evaluation and a search for the possibility of recurrent stenosis is recommended, especially in view of the increasing frequency of prophylactic carotid endarterectomy. (Arch Surg 1982;117:1082-1085) References 1. Callow AD: An overview of the stroke problem in the carotid territory . Am J Surg 1980;140:181-191.Crossref 2. Stoney RJ, String ST: Recurrent carotid stenosis . Surgery 1976;80:705-710. 3. McBride K, Callow AD: Recurrent stenosis after carotid endarterectomy: A limited survey , in Bernhard VM, Towne JB (eds): Complications in Vascular Surgery . New York, Grune & Stratton Inc, 1980, pp 259-273. 4. Szilagyi DE, Smith RF, Whitney DG: The durability of aorto-iliac endarteriectomy: A roentgenologic and pathologic study of late recurrence . Arch Surg 1964;89:827-839.Crossref 5. Imparato AM, Bracco A, Kim GE, et al: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions . Surgery 1972;72:1007-1017. 6. Cossman D, Callow AD, Stein A, et al: Early restenosis after carotid endarterectomy . Arch Surg 1978;113:275-278.Crossref 7. Fonkalsrud E, Sanchez M, Zerubavel R, et al: Arterial endothelial changes after ischemia and perfusion . Surg Gynecol Obstet 1976;142:715-721. 8. Hertzer NR, Martinez BD, Beven EG: Recurrent stenosis after carotid endarterectomy . Surg Gynecol Obstet 1979;149:360-364. 9. Dirrenberger RA, Sundt TM: Carotid endarterectomy: Temporal profile of the healing process and effects of anticoagulation therapy . J Neurosurg 1978;48:201-219.Crossref 10. Blaisdell FW, Lim R, Hall AD: Technical result of carotid endarterectomy: Arteriographic assessment . Am J Surg 1967;114:239-246.Crossref 11. Javid H, Ostermiller WE Jr, Hengesh JW, et al: Natural history of carotid bifurcation atheroma . Surgery 1970;67:80-86. 12. Julian OC, Javid H: Surgical management of cerebral arterial insufficiency . Curr Probl Surg March 1971, pp 1-42. 13. Sundt TM Jr, Sandok BA, Whisnant JP: Carotid endarterectomy: Complications and preoperative assessment of risk . Mayo Clin Proc 1975;50:301-306. 14. Edwards WS, Wilson TAS, Bennett A: The long-term effectiveness of carotid endarterectomy in prevention of strokes . Ann Surg 1968;168:765-770.Crossref 15. French BN, Rewcastle NB: Recurrent stenosis at site of carotid endarterectomy . Stroke 1977;8:597-605.Crossref 16. Ross R, Glomset JA: The pathogenesis of atherosclerosis . N Engl J Med 1976;295:369-377, 420-425.Crossref 17. Turnipseed WD, Berkoff HA, Crummy A: Postoperative occlusion after carotid endarterectomy . Arch Surg 1980;115:573-574.Crossref 18. Cossman DV, Treiman RL, Foran RF, et al: Surgical approach to recurrent carotid stenosis . Am J Surg 1980;140:209-211.Crossref 19. Kremen JE, Gee W, Kaupp HA, et al: Restenosis or occlusion after carotid endarterectomy: A survey with ocular pneumoplethysmography . Arch Surg 1979;114:608-610.Crossref 20. Kartchner MM: Non-invasive data from post-operative carotid surgery patients. Read before the San Diego Symposium on Non-Invasive Diagnostic Techniques in Vascular Disease, San Diego, Sept 11, 1979.
Archives of Surgery – American Medical Association
Published: Aug 1, 1982