Early Restenosis After Carotid Endarterectomy with Vein Patch Angioplasty

Abstract

Restenosis of the carotid artery after endarterectomy is of major concern, for it may increase the risk of cerebrovascular accidents to preoperative levels. The records of 173 consecutive carotid endarterectomy (CEA) cases were reviewed retrospectively, to assess the role of vein patch angioplasty in reducing the incidence of restenosis of the carotid artery after endarterectomy. All patients had patch angioplasty during CEA; 154 operations were done with autogenous vein patch and 19 with synthetic patches. One patient had postoperative carotid thrombosis. Evaluation of 134 carotid arteries with duplex ultrasonography at four to eight weeks postoperatively showed that 8 patients (6%) had recurrent stenosis of more than 40%. Six of these stenoses resolved by one year and one had improved from grade III to grade I stenosis. Of 107 patients followed up at one year, 7 (6.5%) had restenosis, all between 40-60%. In view of the low rate of recurrent stenosis and postoperative thrombosis, similar to that reported by other authors, the authors conclude that vein patch angioplasty should be done during CEA. It also seems that most of the early postoperative (four to eight weeks) duplex abnormalities will resolve over time and do not represent recurrent stenosis.