title: The etiology of symptoms in patients with recurrent carotid stenosis.
abstract: We performed 33 carotid endarterectomies in 29 patients for recurrent carotid stenosis. The interval between the initial and second operations ranged from six weeks to 11 years with a mean of 56 months. Three types of pathologic lesions were identified: (1) recurrent atherosclerosis (RA), (2) neointimal fibromuscular hyperplasia (NFH), and (3) lesions with elements of both RA and NFH (complex lesions). Histologic examination of early-recurring lesions (less than three years) revealed NFH in 17 patients and one complex lesion. Late-recurring lesions (three years or later) were due to atherosclerosis in eight vessels, NFH in four, and both RA and NFH in three. Focal neurologic symptoms occurred in 25 (76%) of 33 vessels, and an embolic source could be identified in 16 (64%) of 25 patients. Embolic events rather than reduced blood flow due to progressive stenosis are more frequent causes of symptoms in patients with recurrent carotid stenosis than was formerly believed.
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery*; D001161:Arteriosclerosis / Q000150:complications; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000209:etiology / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000150:complications; D008297:Male; D012008:Recurrence