title: Managing recurrent carotid artery disease with redo carotid endarterectomy: a 10-year retrospective case series.
abstract: BACKGROUND
  Choosing the optimal treatment modality for patients with recurrent carotid artery stenosis depends upon many variables, including the etiology of the recurrent plaque morphology and the location of the recurrent lesion. The most important considerations for interventions are the safety, short- and long-term durability of the repair, and the surgical team's skills and experience. We reviewed the results of our operative series on primary and redo carotid endarterectomy (CEA) data to evaluate the short- and long-term outcomes of surgical intervention. We also evaluated the relationship between plaque lesion characteristics with respect to the development of recurrent stenosis.
  
  
  METHODS
  The charts of all patients who underwent CEAs and redo CEAs (RCEAs) performed by one vascular surgeon were retrospectively reviewed for a 10-year period. Preoperative data, including patients' demographics and interval between the primary CEAs and RCEAs, were recorded and summarized. The surgical procedure, location, and morphologic characteristics of the carotid lesions (primary or recurrent) were also recorded. Surgical outcomes, including local complications, systemic complications, length of stay, restenosis rate, and short-and long-term stroke rates, were reviewed.
  
  
  RESULTS
  From 1997 to 2007, one vascular surgeon performed 1324 consecutive CEA procedures on a total of 1198 patients. Restenosis that required RCEA was performed on 212 patients, which included 192 first RCEAs and 27 second RCEAs. All patients who underwent primary CEAs were original patients of the senior author. RCEAs were performed on 7 of our original patients, and the remaining RCEA cases were referred patients. The interval from primary CEA to first RCEA ranged from 2 months to 29 years, with an average of 4.4 years. In this group of patients, the male/female ratio was 45%/55% and average age was 61 years (range 38-74 years). Eighty-three percent (159 of 192) used tobacco, compared with 54% in the primary CEA group. Also, in this group of patients, cranial nerve injuries occurred in 25 of the 192 patients (13%). The majority of these injuries were temporary, but 4 patients had prolonged injury and 1 patient had a permanent injury. One nonfatal myocardial infarction (MI) occurred. There were no incidents of stroke or death. Significant restenosis occurred in 3 patients (1.5%) over an average of 2.1 years. These statistics compare favorably with finding from our series of primary CEAs, in which cranial nerve injury was 4% (44 of 1105), postoperative myocardial infarction was 0.5% (6 of 1105), stroke rate was 0.18% (2 of 1105), and death rate was 0%, with significant restenosis occurring in 0.36% (4 of 1105) of patients over an average of 4.4 years.
  
  
  CONCLUSIONS
  In our retrospective study, the stroke and restenosis rates after RCEAs were similar to those after primary CEA. Therefore, we consider RCEA to be a viable therapeutic option in patients with carotid disease that recurs after a primary CEA.
authors: Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors: A George
authors: AG
authors: Akingba
authors: Division of Vascular Surgery, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA.
authors: Michael
authors: M
authors: Bojalian
authors: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
authors: Changyu
authors: C
authors: Shen
authors: Division of Vascular Surgery, Detroit Medical Center/Wayne State University, Detroit, MI. Electronic address: reedrub@icloud.com.
authors: Jeffrey
authors: J
authors: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D020209:Cranial Nerve Injuries / Q000209:etiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome