title: Carotid restenosis after endarterectomy and stenting: a critical issue?
abstract: BACKGROUND
  Carotid artery stenting (CAS) is currently considered a valid alternative to carotid endarterectomy (CEA) for the prevention of stroke in high-risk patients. One of the most important issues for both of these techniques is carotid restenosis. The aim of our study was to evaluate the incidence of post-CEA and post-CAS restenosis in a large cohort of patients in a single high-volume center.
  
  
  METHODS
  Between December 2000 and December 2010, 2453 CEA and 2628 CAS procedures were performed in the Vascular and Endovascular Surgery Unit at our institution. The mean age of patients was 73.8 years (range 55‒89 years), 78% of whom were men. Indications for carotid revascularization were: presence of symptomatic carotid artery stenosis of >70%, or asymptomatic stenosis of at least 80%, especially in patients with vulnerable plaques.
  
  
  RESULTS
  Mild and long-term results after CEA and CAS were similar. The overall perioperative neurologic complication rate (minor and major stroke) was similar in the 2 groups. At 1-year follow-up the restenosis rate after CEA was 1.58%. In-stent restenosis after CAS occurred in 1.67% of the procedures. All but 3 arteries had been treated for postsurgical restenosis. All lesions were approached secondarily with endovascular procedures. Statistical analysis demonstrated that post-CEA restenosis was the most important predictive factor for the development of in-stent restenosis after CAS.
  
  
  CONCLUSIONS
  This review of our 10-year experience confirms that patients who develop restenosis after CEA are also prone to developing in-stent restenosis after CAS.
authors.affiliation: Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.forename: Pasqualino
authors.initials: P
authors.lastname: Sirignano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galzerano
authors.forename: Gianmarco
authors.initials: G
authors.lastname: de Donato
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D016893:Carotid Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D015897:Comorbidity; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome