Patients who have secondary recurrent carotid stenoses can safely undergo a third carotid operation. Female habitual smokers with elevated lipid levels and an early restenosis appear to be at high risk of secondary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more durable than patch angioplasty.
present if there was a change to adjacent groups that persisted for at least two consecutive visits.Results: Regression occurred in 43 (3.8%), no change in 856 (76.4%), progression in 190 (17.0%) and occlusion in 32 (2.8%) patients. Ipsilateral ischemic event rate was 0% with regression, 10.3% with no change, 17.4% with progression and 28.1% with occlusion (c 2 , P < .001). The corresponding values for stroke were 0%, 4.7%. 7.9% and 12.5%, respectively (c 2 , P ¼ .029).Using Kaplan-Meier curves, in the subgroup of patients with stenosis 70-95% the average annual ipsilateral ischemic event rate was 2.25% in patients with regression or absence of change and 4.75% in patients with progression (P < .001; OR, 2.15, 95% CI, 1.44-3.21). The corresponding values for stroke were 1.12% and 2.50% (P ¼ .025; OR, 2.01, 95% CI, 1.14-3.54). In the subgroup of occlusion the average annual ipsilateral ischemic event rate was 5.6% and for stroke 2.6%.In a logistic regression analysis, the severity of the final stenosis (P ¼ .005; OR, 1.28; 95% CI, 1.08-1.53) and progression (P ¼ .034; OR, 1.47; 95% CI, 1.03-2.10) were both independent predictors of ipsilateral ischemic events.Conclusions: The degree of stenosis and progression are both associated with the occurrence of ischemic events and stroke. Progression identifies a group at increased risk of stroke.
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