Carotid surgery following previous carotid endarterectomy is safe and effective

Ahmed M. Abou-Zamzam, Gregory (Greg) Moneta, Gregory Landry, Richard A. Yeager, James Edwards, Donald McConnell, Lloyd M. Taylor, John M. Porter

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

With the perceived high risk of repeat carotid surgery, carotid angioplasty and stenting have been advocated recently as the preferred treatment of recurrent carotid disease following carotid endarterectomy. An experience with the operative treatment of recurrent carotid disease to document the risks and benefits of this procedure is presented. A review of a prospectively acquired vascular registry over a 10-year period (Jan. 1990-Jan. 2000) was undertaken to identify patients undergoing repeat carotid surgery following previous carotid endarterectomy. All patients were treated with repeat carotid endarterectomy, carotid interposition graft, or subclavian-carotid bypass. The perioperative stroke and death rate, operative complications, life-table freedom from stroke, and rates of recurrent stenosis were documented. During the study period 56 patients underwent repeat carotid surgery, comprising 6% of all carotid operations during this period. The indication for operation was symptomatic disease recurrence in 41 cases (73%) and asymptomatic recurrent stenosis ≥80% in 15 cases (27%). The average interval from the prior carotid endarterectomy to the repeat operation was 78 months (range 3 weeks-297 months). The operations performed included repeat carotid endarterectomy with patch angioplasty in 31 cases (55%), interposition grafts in 19 cases (34%), and subclavian-carotid bypass in 6 cases (11%). There were three perioperative strokes with one resulting in death for a perioperative stroke and death rate of 5.4%. One minor transient cranial nerve (CN IX) injury occurred. Mean follow-up was 29 months (range, 1-116 months). Life-table freedom from stroke was 95% at 1 year and 90% at 5 years. Recurrent stenosis (≥80%) developed in three patients (5.4%) during follow-up, including one internal carotid artery occlusion. Two patients (3.6%) underwent repeat surgery. Repeat surgery for recurrent cerebrovascular disease following carotid endarterectomy is safe and provides durable freedom from stroke. Most patients are candidates for repeat endarterectomy with patching, but interposition grafting is often required. These results strongly support the continued role of repeat carotid surgery in the treatment of recurrent carotid disease.

Original languageEnglish (US)
Pages (from-to)263-270
Number of pages8
JournalVascular and Endovascular Surgery
Volume36
Issue number4
StatePublished - Jul 2002

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Carotid Endarterectomy
Reoperation
Stroke
Pathologic Constriction
Life Tables
Angioplasty
Glossopharyngeal Nerve Injuries
Transplants
Cerebrovascular Disorders
Endarterectomy
Mortality
Internal Carotid Artery
Blood Vessels
Registries
Therapeutics
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Carotid surgery following previous carotid endarterectomy is safe and effective. / Abou-Zamzam, Ahmed M.; Moneta, Gregory (Greg); Landry, Gregory; Yeager, Richard A.; Edwards, James; McConnell, Donald; Taylor, Lloyd M.; Porter, John M.

In: Vascular and Endovascular Surgery, Vol. 36, No. 4, 07.2002, p. 263-270.

Research output: Contribution to journalArticle

Abou-Zamzam, AM, Moneta, GG, Landry, G, Yeager, RA, Edwards, J, McConnell, D, Taylor, LM & Porter, JM 2002, 'Carotid surgery following previous carotid endarterectomy is safe and effective', Vascular and Endovascular Surgery, vol. 36, no. 4, pp. 263-270.
Abou-Zamzam, Ahmed M. ; Moneta, Gregory (Greg) ; Landry, Gregory ; Yeager, Richard A. ; Edwards, James ; McConnell, Donald ; Taylor, Lloyd M. ; Porter, John M. / Carotid surgery following previous carotid endarterectomy is safe and effective. In: Vascular and Endovascular Surgery. 2002 ; Vol. 36, No. 4. pp. 263-270.
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