Early postsurgical carotid restenosis: redo surgery versus angioplasty/stenting.
OBJECTIVE
To compare the results of balloon angioplasty/stenting (BA/S) versus redo surgery in patients with early carotid restenosis.


METHODS
Sixty-one patients (35 women; mean age 69 years, range 46-82) with early restenosis (<24 months from the primary endarterectomy) in 63 carotid arteries were treated during a 5-year period; 41 patients (41 arteries) had redo surgery (group A) and 20 patients (22 arteries) had BA/S (group B). Patients were followed regularly with duplex ultrasound to detect >or=50% recurrent restenosis (RRS) after redo surgery or BA/S. Kaplan-Meier life-table analysis was used to estimate the stroke-free survival rates and freedom from >or=50% RRS.


RESULTS
The demographic and clinical characteristics were comparable for both groups, as were the perioperative stroke and death rates (2.4% and 0% for group A, respectively, versus 4.5% and 0% for group B, p=0.46). Group A had a 12% incidence of cranial nerve injury (all transient) versus 0% for group B (p=0.11); however, group B had a higher incidence of >or=50% RRS than group A (32% versus 0%, p=0.0003). The stroke-free survival rates for redo surgery at 6, 12, 24, 36, and 48 months were 100%, 100%, 100%, 100%, and 88% versus 95%, 95%, 84%, 84%, and 63% for BA/S (p=0.067). Redo surgery had a 100% freedom from >or=50% RRS at the same time intervals, while recurrent restenosis rates for the BA/S patients were 95%, 86%, 69%, 52%, and 52% (p<0.0001).


CONCLUSIONS
BA/S and redo surgery have comparable stroke and death rates in the treatment of early RCS; however, redo surgery is associated with cranial nerve injuries (transient), while stent patients have a higher incidence of recurrent lesions. These considerations should be kept in mind when selecting the appropriate treatment for patients with early postsurgical restenosis.
AbuRahma
Ali F
AF
Department of Surgery, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, West Virginia, USA. Ali.AbuRahma@Camcare.com
Bates
Mark C
MC
Wulu
John T
JT
Stone
Patrick A
PA
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors