RECURRENT CAROTID STENOSIS - A 5-YEAR SERIES OF 65 REOPERATIONS

From 1979 to 1983, 1726 carotid endarterectomies were performed at the Cleveland Clinic. During this period, 39 men (mean age, 60 yr) and 22 women (mean age, 63 yr) required 65 reoperations (3.8%) for correction of recurrent carotid stenosis occurring 3 to 194 mo. (mean, 42 mo.) after previous endarterectomy at this center (N=43) or elsewhere (N=22). Remedial procedures were necessary because of restenosis demonstrated by routine noninvasive testing in 32 asymptomatic lesions and because of neurologic symptoms in 33 others. The mean recurrence interval was 57 postoperative mo. for atherosclerosis (N = 37) in comparison to 21 mo. (P = 0.0007) for myointimal hyperplasia (N = 28), and was 48 mo. for men in comparison to 31 mo. for women (P = NS). Hypercholesterolemia appeared to be associated with late atherosclerotic recurrence (P = 0.05), but was not a feature of myointimal hyperplasia. Patch angioplasty (N = 59) or graft replacement (N = 3) was employed during 62 of the 65 reoperations, with a total of 2 operative deaths (3.1%), 1 nonfatal stroke (1.5%), and 6 transient cranial nerve injuries (9.2%). Three unrelated late deaths have occurred within a mean follow-up period of 23 mo., but only 3 patients have experienced subsequent neurologic symptoms.