title: Open Versus Endovascular Treatment for Patients with Post-Carotid Endarterectomy Restenosis: Early and Long-term Results.
abstract: BACKGROUND
  The aim of this study is to assess and compare the short- and long-term results of carotid artery stenting (CAS) and redo surgery in patients with restenosis after carotid endarterectomy (CEA).
  
  
  METHODS
  From January 1988 to December 2014, 44 consecutive patients were treated for carotid restenosis (CR): 23 redo-CEA (52.3%) and 21 CAS (47.7%). Data from these patients were prospectively collected in a dedicated database. Early results and 3-year end points were analyzed and compared between groups with χ2test, Kaplan-Meier curves, and Breslow test.
  
  
  RESULTS
  Demographic characteristics and comorbidity were similar in both groups, except for arterial hypertension and chronic renal insufficiency which were higher in the CAS group. CR was symptomatic in 7 patients in the redo-CEA group (30.4%) and 1 (4.8%) in CAS (P = 0.04). No differences were found in the time period between primary CEA and reintervention, critical carotid stenosis, or contralateral carotid occlusion. Median follow-up was 61.5 months. In the redo-CEA group, 1 patient (4.3%) had a perioperative transient ischemic attack and 3 (13%) experienced cranial nerve injury with complete regression at 30 days. No differences were found between groups in terms of early and long-term mortality, neurologic morbidity, and overall morbidity. The rate of secondary restenosis and freedom from reintervention was similar in both groups during follow-up.
  
  
  CONCLUSIONS
  Both CAS and redo-CEA are suitable options for patients with CR. CAS might be the treatment of choice due to the risk of cranial nerve injuries in redo-CEA. When CAS is contraindicated, redo-CEA remains a safe and effective treatment option.
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain. Electronic address: pablo_mdm@hotmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: Marques de Marino
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Isaac
authors.initials: I
authors.lastname: Martinez Lopez
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Manuela Maria
authors.initials: MM
authors.lastname: Hernandez Mateo
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Cernuda Artero
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Maday
authors.initials: M
authors.lastname: Cabrero Fernandez
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Reina Gutierrez
authors.affiliation: Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Serrano Hernando
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D020209:Cranial Nerve Injuries / Q000209:etiology; D016208:Databases, Factual; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome