Carotid endarterectomy for recurrent stenosis

Mansour, M. Ashraf; Kang, Seung-Min; Baker, William H.; Watson, William C.; Littooy, Fred N.; Labropoulos, Nicos; Greisler, Howard P.

doi:10.1016/s0741-5214(97)70217-9

Cited by 86 publications

(64 citation statements)

References 25 publications

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“…This number compares favorably with other similar studies. Mansour et al 10 reported transient or permanent cranial nerve deficits in 7.3% of redo CEAs, whereas Zarins 28 reported the incidence of cranial nerve palsies to be as high as 20%.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of recurrent carotid stenosis after primary CEA ranges from 10% to 25%. [3][4][5][6][7][8][9][10][11][12] Reoperation has been considered necessary in only 1% to 8% of cases. [3][4][5][6]12 Given that there has been an overall increase in the number of primary CEAs being performed, it follows that the total number of reoperations will also increase.…”

mentioning

confidence: 99%

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Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

AbuRahma

Jennings

Wulu

et al. 2001

Stroke

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Background and Purpose-Several authorities have recently advocated carotid stenting for recurrent carotid stenosis because of the perception that redo surgery has a higher complication rate than primary carotid endarterectomy (CEA). This study compares the early and late results of reoperations versus primary CEA. Methods-All reoperations for recurrent carotid stenosis performed during a recent 7-year period by a single vascular surgeon were compared with primary CEA. Because all redo CEAs were done with polytetrafluoroethylene (PTFE) or vein patch closure, we only analyzed those primary CEAs that used the same patch closures. A Kaplan-Meier life-table analysis was used to estimate stroke-free survival rates and freedom from Ն50% recurrent stenosis. Results-Of 547 primary CEAs, 265 had PTFE or saphenous vein patch closure, and 124 reoperations had PTFE or vein patch closure during the same period. Both groups had similar demographic characteristics. The indications for reoperation and primary CEA were symptomatic stenosis in 78% and 58% of cases and asymptomatic Ն80% stenosis in 22% and 42% of cases, respectively (PϽ0.001). The 30-day perioperative stroke and transient ischemic attack rates for reoperation and primary CEA were 4.8% versus 0.8% (Pϭ0.015) and 4% versus 1.1%, respectively, with no perioperative deaths in either group. Cranial nerve injury was noted in 17% of reoperation patients versus 5.3% of primary CEA patients; however, most of these injuries were transient (PϽ0.001). Mean hospital stay was 1.8 days for reoperation versus 1.6 days for primary CEA. Cumulative rates of stroke-free survival and freedom from Ն50% recurrent stenosis for reoperation and primary CEA at 1, 3, and 5 years were 96%, 91%, and 82% and 98%, 96%, and 95% versus 94%, 92%, and 91% and 98%, 96%, and 96%, respectively (no significant differences). Conclusions-Reoperation carries higher perioperative stroke and cranial nerve injury rates than primary CEA. However, reoperations are durable and have stroke-free survival rates that are similar to primary CEA. These considerations should be kept in mind when carotid stenting is recommended instead of reoperation.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Redo Carotid Endarterectomy Versus Primary Carotid Endarterectomy

AbuRahma

Jennings

Wulu

et al. 2001

Stroke

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“…The decision to perform surgery on patients with symptomatic or asymptomatic restenosis should be performed with the knowledge that there is an increased risk of stroke and death, as well as an increased risk of local complications such as cranial nerve injury and wound hematoma. 33 The increased operative risk may be due to differences in pathology between primary atherosclerotic stenosis and early restenosis, which is commonly due to smooth myointimal hyperplasia, rather than atherosclerotic plaque. 30,34,35 The issue of risk of CEA in relation to the timing of surgery can be separated into the question of the risk of surgery in the acute phase (ie, in patients with stroke in evolution and crescendo TIAs) and whether the risk of surgery differs between the subacute phase (first few weeks) and the nonacute phase in those patients who are neurologically stable.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of the Risks of Carotid Endarterectomy in Relation to the Clinical Indication for and Timing of Surgery

Bond¹,

Rerkasem²,

Rothwell³

2003

Stroke

252

152

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“…The use of patches is not well established yet. 31,32 We think the selective use of patches in small-caliber arteries, as done in this series, is adequate.…”

Section: -14mentioning

confidence: 78%