title: Durability of surgery for restenosis after carotid endarterectomy.
abstract: BACKGROUND
  The role of carotid surgery for the management of restenosis after carotid endarterectomy (CEA) is challenged by carotid artery stenting (CAS). We reviewed redo CEA in a consecutive series of patients to determine the safety, durability, and long-term benefit associated with repeat surgical treatment for restenosis.
  
  
  METHODS
  A consecutive series of 73 redo procedures in 72 patients (57% men) with a mean age 66 years (range, 49-81 years) was analyzed. The mean interval between prior CEA and redo CEA was 53 months (range, 8-192 months). Operative indications included symptomatic restenosis in 28 patients (38%). A patch angioplasty was performed in 62 patients (85%). The main outcome measures included perioperative and late stroke and death, and the development of secondary restenosis.
  
  
  RESULTS
  There were no perioperative deaths or strokes. During a mean follow-up of 52 months (range, 12-144 months), the Kaplan-Meier cumulative survival was 85% at 5 years. At 5 years, the cumulative rate of freedom from all strokes was 98%, and the freedom from ipsilateral stroke was 100%. After secondary procedures, re-recurrent stenosis > or =50% occurred in 10 patients (13.7%). The cumulative freedom from re-restenosis (> or =50%) was 85% at 5 years. Five patients (7%) received tertiary carotid reconstructions.
  
  
  CONCLUSIONS
  Repeat CEA for recurrent stenosis can be performed safely with excellent long-term protection from stroke. These data provide a standard against which the results of CAS can be compared.
authors.affiliation: Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands. gjdeborst@hotmail.com <gjdeborst@hotmail.com>
authors.forename: Gert J
authors.initials: GJ
authors.lastname: de Borst
authors.forename: Pieter
authors.initials: P
authors.lastname: Zanen
authors.forename: Jean-Paul P
authors.initials: JP
authors.lastname: de Vries
authors.forename: Erik D
authors.initials: ED
authors.lastname: van de Pavoordt
authors.forename: Rob G
authors.initials: RG
authors.lastname: Ackerstaff
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome