title: Spontaneous regression of restenosis after CEA: significance of preoperative plaque characteristics under duplex ultrasound; clinical investigation.
abstract: BACKGROUND
  Restenosis is a postoperative complication after carotid endarterectomy (CEA). The natural clinical course of restenotic lesions is not yet fully understood. This study was aimed at detecting the pattern of restenotic lesions by way of following the plaque thickness under duplex ultrasound, and the possible relationship between the postoperative changes of restenotic lesions and the preoperative plaque characteristics.
  
  
  METHODS
  Serial duplex ultrasound follow-up studies were conducted postoperatively, and intima-media thickness (IMT) was measured to detect restenosis changes. Among 381 cases of CEA, including 25 cases of restenosis, 11 were eligible for further analysis.
  
  
  RESULTS
  Of the 11 cases of restenosis, four showed a gradual increase in IMT, and five showed a temporary increase followed by a decrease in IMT. All cases in the former group showed isoechogenic or hypoechogenic plaques under preoperative duplex ultrasound. In contrast, all cases in the latter group demonstrated calcified plaques together with acoustic shadows.
  
  
  CONCLUSIONS
  These postoperative chronological IMT data demonstrate two changing patterns of restenosis, implying the existence of two distinct entities. In addition, these results suggest that restenosis after removal of a calcified plaque, which supposedly forms secondary to myointimal hyperplasia, may be a temporary phenomenon that acutely develops in response to a dissection maneuver during surgery. Because our speculation is based on a small number of cases, further study is warranted to better understand the pathophysiology of restenosis regression.
authors: Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, 2-8-4 Musashidai, Fuchu, Tokyo, 183-0042, Japan, takami-tky@umin.ac.jp.
authors: Hirokazu
authors: H
authors: Takami
authors: Tohru
authors: T
authors: Mizutani
authors: Takahiro
authors: T
authors: Ota
authors: Ryuji
authors: R
authors: Yuyama
mesh_terms: D017536:Carotid Artery, Common / Q000473:pathology / Q000601:surgery; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods