title: Carotid artery closure for endarterectomy does not influence results of angioplasty-stenting for restenosis.
abstract: OBJECTIVE
  Carotid angioplasty and stenting (CAS) has been recommended by some authors for the management of postendarterectomy restenosis. However, some authors have expressed concern about the influence of primary closure and patch angioplasty performed during carotid endarterectomy (CEA) on the incidence rate of complications after CAS.
  
  
  METHODS
  We analyzed our consecutive series of 54 CAS procedures performed for restenosis after prior CEA. These procedures accounted for 75% of the 72 CAS procedures performed at our institution for all indications during the last 4 years. Of these 54 patients, 28 (52%) were men and 26 (48%) were women, with a mean age of 69 years. The mean clinical follow-up period was 18 months (range, 1 to 48 months). The mean interval between prior CEA and CAS was 16 months (range, 6 to 62 months). Nineteen patients were symptomatic (35%), and 35 were asymptomatic (65%). The mean severity of restenosis was 84% +/- 7% (standard deviation). The mean residual stenosis after CAS was 8% +/- 3% (standard deviation).
  
  
  RESULTS
  Among the 54 prior CEAs, eight cases were performed with primary closure (15%), five procedures used patch closure with autologous vein (9%), and 41 operations used Dacron patch closures (76%). All patients were managed successfully with CAS with predeployment angioplasty with low profile balloons, self-expanding stents, and poststent angioplasty to approximate the transverse diameter of the carotid artery. No instances of contrast extravasation, arterial disruption, or subintimal dissection were observed. One stroke (1.8%), a retinal infarction with partial field of vision loss, occurred in a patient with prior CEA and Dacron patch closure, and no deaths were observed in the series.
  
  
  CONCLUSIONS
  Performance of CAS for restenosis after CEA with autologous or synthetic patch angioplasty was technically successful in all 54 procedures. The method of closure of the arteriotomy during CEA, primary closure or patch angioplasty, did not influence the incidence of complications.
authors.affiliation: Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey--New Jersey Medical School, Newark 07103, USA. hobsonrw@umdnj.edu
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hobson
authors.forename: Brajesh K
authors.initials: BK
authors.lastname: Lal
authors.forename: Elie Y
authors.initials: EY
authors.lastname: Chakhtoura
authors.forename: Jonathan
authors.initials: J
authors.lastname: Goldstein
authors.forename: Richard
authors.initials: R
authors.lastname: Kubicka
authors.forename: Paul B
authors.initials: PB
authors.lastname: Haser
authors.forename: Frank T
authors.initials: FT
authors.lastname: Padberg
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pappas
authors.forename: Zafar
authors.initials: Z
authors.lastname: Jamil
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D017536:Carotid Artery, Common / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome