Restenosis after carotid surgery.
On the basis of personal experience and reports in the literature, the paper examines the incidence of restenosis after carotid surgery, its potential morbidity and the results of its treatment. The incidence of stenosis after carotid surgery is described in a series of 253 patients given carotid TEAs in 1992-98 and followed up at 1, 3, 6 and 12 months with yearly check-ups thereafter. The group's age range was 64-70 and it included 35% females, 65% males. The initial surgical procedure was a standard TEA with or without patching. Identified by colour Doppler scan, cases of restenoses were examined angiographically in the presence of significant symptoms and haemodynamic disorders. This group constituted 7.5% of the personal series and was classified on the basis of clinical, morphological, topographical and haemodynamic criteria. Only 21% of the restenosis cases required repeat surgery: 2 classic procedures and 2 endovascular operations. No complications ensued and all these patients were symptom-free at 84 months' follow-up. A comparison of these data with reports in the literature confirms an increasing incidence of restenosis after carotid surgery in recent years, which partly reflects more accurate diagnosis. It is concluded that indications to surgery should take greater account of the lesion's histological and clinical characteristics and the increased risk of peripheral nerve damage in repeat surgery. The alternative endovascular approach will need to be examined on the basis of bigger case series and longer, more meaningful follow-ups before any definitive conclusions can be reached though the endovascular approach does seem to represent the future of treatment in this particular sector.
Maraglino
V
V
Vascular Surgery Division, SS. Annunziata Hospital, Taranto, Italy.
Gerardi
P
P
Piccinni
C
C
D000368:Aged; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence