[Carotid restenosis: clinical significance and indications for reintervention].
Carotid restenosis is defined as a new > 50% diameter-reducing lesion present in sites of previous surgery. The clinical aspects of this complication are strongly connected with their anatomopathologic evolution: fibromuscular hyperplasia in early recurrent disease, atherosclerotic degeneration in the later lesions. Routine postendarterectomy duplex surveillance is able to detect this pathologic evolution. On 570 surgically treated carotid artery a postoperative duplex surveillance was made at 3, 6, 12 months and then yearly. Totally 42 cases of recurrent stenosis (7.3%) were present: in seven cases (16.6%) with a complicated restenosis the patients were symptomatic. In 27 cases (64.2%) restenosis was < 75%, in 8 cases (19.2%) > 75%. Indication to surgery was given for all the complicated restenosis and for high grade stenosis (> 75%). In the 27 cases of restenosis < 75% a conservative therapy together with duplex surveillance was applied: in none of these cases the restenosis increased in an average follow-up of 13.7 months. In the reoperated cases we didn't observe any mortality nor postoperative stroke. With regard to their mainly hyperplastic origin, carotid restenosis are low symptomatic and with a quite benign evolution. Surgical reintervention is to be limited to the symptomatic cases and to the asymptomatic high grade stenosis cases. A particular attention should be reserved to the morphologic characteristics of the lesion in order to detect the atherosclerotic degeneration that might cause cerebral symptoms.
D'Addato
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Dipartimento di Scienze Chirurgiche e Anestesiologiche Università.
Freyrie
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D000800:Angioplasty, Balloon; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation
Le restenosi carotidee: significato clinico e indicazioni al reintervento.