Restenosis after carotid endarterectomy

Abstract

Multiple randomised trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CE) in reducing the risk of stroke. The long-term patency of the carotid artery after CE is an important factor in the success of the operation. The incidence of recurrent carotid stenosis (excluding residual lesions) ranges from 1 to 37% with only 0-8% of patients having restenosis-related symptoms (1). Generally, recurrent carotid stenosis is attributed to myointimal hyperplasia during the early postoperative period (within 3 years) or recurrent atherosclerosis thereafter. The management of recurrent carotid stenosis after CE remains a dilemma. It is generally accepted that operation for significant recurrent carotid stenosis is indicated for symptomatic patients, and several authors also recommend CE for >80% asymptomatic recurrent stenosis. Treatment of recurrent carotid stenosis involves repeat endarterectomy with patch angioplasty, although more recently endovascular techniques have been used.

Carotid Artery Aneurysm

“…Restenosis of a CEA is relatively rare, occurring in a range of 1-37% of patients, with only 0-8% having restenosis-related symptoms in one clinical trial. 1 In recent trials, the fi gures show an incidence rate of restenosis to be closer to 6-14%, which equates to an average annual restenosis or occlusion rate of 1.5-4.5%. A review of this also revealed a risk of recurrent stenosis of 10% in the fi rst year, 3% in the second, and 2% in the third, suggesting that the rate of restenosis may not be linear throughout the follow-up period.…”

“…1 With the improvement in diagnostic imaging and surgical techniques, CEAs are now being performed more than at any other time in the history of the operation. 1 CEAs are usually performed on symptomatic patients with a greater than 70% stenosis. Clinical trials have proven CEA to be benefi cial in helping to reduce the number of strokes today.…”

“…A review of this also revealed a risk of recurrent stenosis of 10% in the fi rst year, 3% in the second, and 2% in the third, suggesting that the rate of restenosis may not be linear throughout the follow-up period. 1 Several reports in the literature have examined the infl uence of factors of restenosis such as age, sex, hypertension, smoking, hyperlipidemia, and diabetes following CEA. 1 None of these factors have clearly outlined a specifi c correlation between restenosis and CEA, but smoking is believed to be the biggest factor.…”

“…1 Several reports in the literature have examined the infl uence of factors of restenosis such as age, sex, hypertension, smoking, hyperlipidemia, and diabetes following CEA. 1 None of these factors have clearly outlined a specifi c correlation between restenosis and CEA, but smoking is believed to be the biggest factor.…”

Use of Micropatterned Thin Film Nitinol in Carotid Stents to Augment Embolic Protection

“…Thin film nitinol (TFN) is a novel material worth considering for developing a low-profile endovascular device [13]. Vacuum sputter deposition process for thin film nitinol is the preferred fabrication method because of the precise controllability of the deposition process and the consistency of the quality of the films [14]. Furthermore, thin film nitinol can be used in small calibre vascular systems as it exhibits superelastic property at body temperature, which improves the device apposition to the vascular wall compared to any synthetic fabric (like polyethylene terephthalate micronet) that typically has wrinkles or permanent deformation.…”