title: Carotid bypass: a safe and durable solution for recurrent carotid stenosis.
abstract: BACKGROUND
  The long-term results of carotid artery stenting (CAS) for post-carotid endarterectomy (CEA) restenosis are disappointing (4-year patency rates: ∼75%). Since 1988, our group has offered carotid bypass (CB) as an alternative to redo CEA and later also to CAS in this setting. The aim of this retrospective study was to investigate early and late outcomes associated with CB in this population.
  
  
  METHODS
  Data were collected from patients treated with CB in the year 2000-2012 for significant/symptomatic post-CEA restenosis (or intra-stent restenosis [ISR] after CAS for post-CEA restenosis). All patients had good life expectancy. CB was performed under loco-regional anesthesia. With the aid of sequential vessel clamping, the graft (great saphenous vein [GSV] or polytetrafluoroethylene) was anastomosed with the common carotid artery (side-to-end) and the distal internal carotid artery (end-to-side). Patients were followed with clinical and duplex scan assessments at 1, 3, and 6 months and yearly thereafter.
  
  
  RESULTS
  The study population comprised 21 patients (mean age 67.3 years; 17 men). CB was performed for post-CEA restenosis (or ISR after CAS for post-CEA restenosis, n=3) 51.2 months (mean) after the previous operation. GSV grafts were used in half of the cases (n=11; 52.4%); temporary shunting was used in 4 (19%) patients. Intraoperative complications (none fatal) occurred in 4 (19%) patients (3 transient peripheral nerve injuries, 1 cervical hematoma). During follow-up (mean 64.8 months), there were no neurologic complications or restenoses. Overall mortality was 33.3% (6 deaths from acute myocardial infarctions, 1 from a ruptured abdominal aortic aneurysm).
  
  
  CONCLUSIONS
  For post-CEA restenosis (or ISR after CAS for post-CEA restenosis), CB offers superior long-term patency rates than CAS (or redo angioplasty) and an acceptable risk of cranial nerve damage.
authors: Division of Vascular Surgery, University of Messina, Messina, Italy.
authors: Francesco
authors: F
authors: Spinelli
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Electronic address: eugenio.martelli@gmail.com.
authors: Eugenio
authors: E
authors: Martelli
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Francesco
authors: F
authors: Stilo
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Narayana
authors: N
authors: Pipitò
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Filippo
authors: F
authors: Benedetto
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Domenico
authors: D
authors: Spinelli
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Domenico
authors: D
authors: Squillaci
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: Giovanni
authors: G
authors: De Caridi
authors: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors: David
authors: D
authors: Barillà
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001807:Blood Vessel Prosthesis; D017536:Carotid Artery, Common / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex