title: Recurrent carotid artery stenosis following endarterectomy: natural history and risk factors.
abstract: OBJECTIVE
  To establish the incidence of restenosis (RES) following carotid endarterectomy (CEA) and evaluate clinical and technical factors related to its development.
  
  
  METHODS
  Prospective non-randomised cohort study.
  
  
  METHODS
  Two hundred and twenty-four patients with 243 CEA between May 1998 and December 2002, were subjected to clinical and haemodynamic follow-up, median follow-up 23 months (1-56). There was selective use of a shunt (17.3%) and patch (61.7%). RES (> or =50%) and severe restenosis, > or =70%, (sRES) were defined as peak systolic velocities of > or =150 and > or =300cm/s (or > or =250cm/s with diastolic velocity >100cm/s), respectively. Rates of RES, symptom development and mortality were analysed using Kaplan-Meier curves. Cox's regression model (hazards ratio/95% CI) was used to evaluate prognostic factors.
  
  
  RESULTS
  We detected 13 sRES (5.3%) (median time 6.1 months) and 30 (12.3%) moderate stenosis (mRES) (median time 3.7 months). Cumulative freedom from sRES at 23 months was 94.2%. Five sRES detected in the first 45 days after the procedure were deemed to be residual restenosis (rRES). Five (38.4%) sRES were symptomatic, 15.3% progressed to occlusion. Patient survival was 98.0 and 96.4% at 12 and 24 months, respectively. Independent risk factors for sRES: female sex (HR: 3.3, 95% CI 1.1-10 p=0.04) and diabetes (HR: 4.5, 95% CI 1.4-13.9 p=0.008).
  
  
  CONCLUSIONS
  Carotid restenosis appears early, is usually low-grade and mostly asymptomatic. Although few stenoses progress to occlusion, women and diabetic patients were at highest risk.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital Clínico de Madrid, Madrid, Spain. mreina.hcsc@salud.madrid.es
authors.forename: T
authors.initials: T
authors.lastname: Reina-Gutiérrez
authors.forename: F J
authors.initials: FJ
authors.lastname: Serrano-Hernando
authors.forename: L
authors.initials: L
authors.lastname: Sánchez-Hervás
authors.forename: A
authors.initials: A
authors.lastname: Ponce
authors.forename: M
authors.initials: M
authors.lastname: Vega de Ceniga
authors.forename: A
authors.initials: A
authors.lastname: Martín
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D015897:Comorbidity; D016894:Endarterectomy, Carotid; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex