Carotid artery disease progression and related neurologic events after carotid endarterectomy

Abstract

Restenosis or contralateral disease progression after CEA, to a level that might warrant consideration for treatment, is very low. The potentially associated stroke rates are also very low and not clearly related to disease progression. With the exception of the postoperative duplex, surveillance within short intervals of <1 or 2 years cannot be justified.

Editor's Choice – Follow-up of Patients After Revascularisation for Peripheral Arterial Diseases: A Consensus Document From the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society for Vascular Surgery

“…In a cohort of 1639 patients, a 50e69% internal carotid artery (ICA) stenosis observed in 282 patients progressed to severe 70e99% stenosis in 32 patients (11.3%) during a mean time of 30.7 AE 26.5 months. 18 Whether serial DUS surveillance confers any benefit remains controversial. DUS surveillance enables monitoring of disease progression in the ipsilateral and contralateral carotid arteries.…”

A systematic review of patch angioplasty versus primary closure for carotid endarterectomy

“…[37][38][39][40] Lack of comparison between PRC and PAC was the reason for exclusion of 20 articles. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Two studies were excluded because they were not available in English. 61,62 Three studies did not report relevant outcome measures related to this study.…”

Primary closure after carotid endarterectomy is not inferior to other closure techniques

“…[8][9][10][11][12] The clinical course of recurrent stenosis is generally benign, and the accompanying neurologic events are roughly 1% to 5%. [11][12][13][14][15][16] To date, there is a general consensus and guideline disfavoring the use of primary closure during CEA, as it may be associated with higher perioperative neurologic events and restenosis rates. 1,2 Recent studies, including Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) and National Surgical Quality Improvement Program (NSQIP) data, have challenged the perioperative outcome differences, whereas the clinical significance of restenosis at such low rates may be minimal.…”