Abstract
Carotid angioplasty and stenting (CAS) has been proposed as a treatment option for carotid occlusive disease in high-risk patients including those with recurrent stenosis (RS) and contralateral occlusion (CO). This study reviews the results of carotid endarterectomy (CEA) in patients with RS and CO. We conducted a retrospective review from our vascular registry of 1670 patients who underwent CEAs (n = 1950) from January 1990 through December 2001. Procedures included RS 86 (4.4%), CO 112 (5.7%), and control 1752 (89.9%). There were 37 strokes in the entire group (1.9%). Among the high-risk group with RS and CO, there were 6 strokes, (RS n = 2, CO n = 4) 3%. There were 31 strokes in the control group 1.8% (p = NS). Postoperative TIAs were observed more frequently in patients with CO (n = 2) or RS (n = 2), 1.8% and 2.3%, respectively (p < 0.05). Neck hematomas, intracerebral hemorrhages, and myocardial infarctions did not differ between groups. Three deaths occurred within 30 days (0.15%); one was a patient with CO. Renal failure and symptomatic disease were each associated with a higher risk of perioperative stroke; among patients with renal failure there were 6 strokes (4.6%) p < 0.05, in symptomatic patients there were 26 strokes (2.7%) p < 0.05. Multivariate logistic regression analysis confirmed that preoperative renal disease and surgery for symptomatic disease were both significant predictors of perioperative stroke (p < 0.05; odds ratio 2.177 and 2.943 respectively) while neither RS nor CO was from these results we concluded that the presence of RS and CO do not increase the risk of perioperative stroke in CEA.
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References
PJ Gagne TS Riles AM Imparato et al. (1991) ArticleTitleRedo endarterectomy for recurrent carotid artery stenosis. Eur J Vasc Surg 5 135–140 Occurrence Handle1:STN:280:By6B2czovFc%3D Occurrence Handle2037084
PJ Gagne TS Riles GR Jacobowitz et al. (1993) ArticleTitleLong-term follow-up of patients undergoing reoperation for recurrent carotid artery disease. J Vasc Surg 18 991–998 Occurrence Handle10.1067/mva.1993.50395 Occurrence Handle1:STN:280:ByuD1cjosl0%3D Occurrence Handle8264056
MA Mattos KJ Hodgson GL Londrey et al. (1992) ArticleTitleCarotid endarterectomy: operative risks, recurrent stenosis, and long-term stroke rates in a modern series. J Cardiovasc Surg (Torino) 33 387–400 Occurrence Handle1:STN:280:By2H3cnpvFU%3D
DA Healy RE Zierler SC Nicholls et al. (1989) ArticleTitleLong-term follow-up and clinical outcome of carotid restenosis. J Vasc Surg 10 662–668 Occurrence Handle10.1067/mva.1989.16374 Occurrence Handle1:STN:280:By%2BD28vovF0%3D Occurrence Handle2585655
MB Das NR Hertzer NB Ratliff et al. (1985) ArticleTitleRecurrent carotid stenosis. A five-year series of 65 reoperations. Ann Surg 202 28–35 Occurrence Handle1:STN:280:BiqB2M%2FmsVM%3D Occurrence Handle4015210
SJ Shumway WH Edwards JM Jenkins et al. (1987) ArticleTitleRecurrent carotid stenosis. Incidence and management. Am Surg 53 61–65 Occurrence Handle1:STN:280:BiiC38nhtFY%3D Occurrence Handle3813217
RJ Stoney ST String (1976) ArticleTitleRecurrent carotid stenosis. Surgery 80 705–710 Occurrence Handle1:STN:280:CSiD1c7ntVU%3D Occurrence Handle1006517
BC Eikelboom RG Ackerstaff H Hoeneveld et al. (1988) ArticleTitleBenefits of carotid patching: a randomized study. J Vasc Surg 7 240–247 Occurrence Handle10.1067/mva.1988.avs0070240 Occurrence Handle1:STN:280:BieC3Mbjt1U%3D Occurrence Handle3276933
RD DeGroote TG Lynch Z Jamil et al. (1987) ArticleTitleCarotid restenosis: long-term noninvasive follow-up after carotid endarterectomy. Stroke 18 1031–1036 Occurrence Handle1:STN:280:BieD2s7lsFQ%3D Occurrence Handle3318001
AF AbuRahma TG Jennings JT Wulu et al. (2001) ArticleTitleRedo carotid endarterectomy versus primary carotid endarterectomy. Stroke 32 2787–2792 Occurrence Handle1:STN:280:DC%2BD3MnptlygtA%3D%3D Occurrence Handle11739974
CB Rockman TS Riles R Landis et al. (1999) ArticleTitleRedo carotid surgery: an analysis of materials and configurations used in carotid reoperations and their influence on perioperative stroke and subsequent recurrent stenosis. J Vasc Surg 29 72–80 Occurrence Handle1:STN:280:DyaK1M7gt1aktA%3D%3D Occurrence Handle9882791
InstitutionalAuthorNameEndarterectomy for asymptomatic carotid artery stenosis (1995) ArticleTitleExecutive committee for the asymptomatic carotid atherosclerosis study. JAMA 273 1421–1428 Occurrence Handle7723155
InstitutionalAuthorNameEndarterectomy for asymptomatic carotid artery stenosisBeneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. (1991) ArticleTitleNorth American Symptomatic Carotid Endarterectomy Trial collaborators. N Engl J Med 325 445–453 Occurrence Handle1852179
CB Rockman W Su PJ Lamparello et al. (2002) ArticleTitleA reassessment of carotid endarterectomy in the face of contralateral carotid occlusion: surgical results in symptomatic and asymptomatic patients. J Vasc Surg 36 668–673 Occurrence Handle10.1016/S0741-5214(02)00115-5 Occurrence Handle12368723
R Karmeli N Lubezky M Halak et al. (2001) ArticleTitleCarotid endarterectomy in awake patients with contralateral carotid artery occlusion. Cardiovasc Surg 9 334–338 Occurrence Handle10.1016/S0967-2109(01)00019-9 Occurrence Handle1:STN:280:DC%2BD3MzlvFKgsg%3D%3D Occurrence Handle11420157
AF AbuRahma P Robinson SM Holt et al. (2000) ArticleTitlePerioperative and late stroke rates of carotid endarterectomy contralateral to carotid artery occlusion: results from a randomized trial. Stroke 31 1566–1571 Occurrence Handle1:STN:280:DC%2BD3czksFWlsQ%3D%3D Occurrence Handle10884455
G New GS Roubin SS Iyer et al. (2000) ArticleTitleSafety, efficacy, and durability of carotid artery stenting for restenosis following carotid endarterectomy; a multicenter study. J Endovasc Ther 7 345–352 Occurrence Handle1:STN:280:DC%2BD3cvnvFKltA%3D%3D Occurrence Handle11032252
GM Biasi SA Ferrari AN Nicolaides et al. (2001) ArticleTitleThe Icaros registry of carotid artery stenting. Imaging in carotid angioplasties and risk of stroke. J Endovasc Ther 8 46–52 Occurrence Handle1:STN:280:DC%2BD3M7ktlehsg%3D%3D Occurrence Handle11220469
RW 2nd Hobson JE Goldstein Z Jamil et al. (1999) ArticleTitleCarotid restenosis: operative and endovascular management. J Vasc Surg 29 228–235 Occurrence Handle9950981
FJ Veith M Amor T Ohki et al. (2001) ArticleTitleCurrent status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders. J Vasc Surg 33 S111–S116 Occurrence Handle10.1067/mva.2001.111665 Occurrence Handle1:STN:280:DC%2BD3M7lslyntw%3D%3D Occurrence Handle11174821
JJ Ricotta MS O’Brien JA DeWeese (1992) ArticleTitleNatural history of recurrent and residual stenosis after carotid endarterectomy: implications for postoperative surveillance and surgical management. Surgery 112 656–661 Occurrence Handle1:STN:280:ByyD3s7itlU%3D Occurrence Handle1411935
AF AbuRahma KR Snodgrass PA Robinson et al. (1994) ArticleTitleSafety and durability of redo carotid endarterectomy for recurrent carotid artery stenosis. Am J Surg 168 175–178 Occurrence Handle1:STN:280:ByuA3s%2FlsVU%3D Occurrence Handle8053521
CR Lattimer KG Burnand (1997) ArticleTitleRecurrent carotid stenosis after carotid endarterectomy. Br J Surg 84 1206–1219 Occurrence Handle1:STN:280:ByiH2Mfpt1U%3D Occurrence Handle9313696
JM Cook BW Thompson RW Barnes (1990) ArticleTitleIs routine duplex examination after carotid endarterectomy justified?. J Vasc Surg 12 334–340 Occurrence Handle10.1067/mva.1990.22759 Occurrence Handle1:STN:280:By%2BA2snls1M%3D Occurrence Handle2204737
WK Washburn WC Mackey M Belkin et al. (1992) ArticleTitleLate stroke after carotid endarterectomy: the role of recurrent stenosis. J Vasc Surg 15 1032–1036 Occurrence Handle10.1067/mva.1992.36056 Occurrence Handle1:STN:280:By2B1cvltlU%3D Occurrence Handle1597885
TF Jr O’Donnell AA Rodriguez JE Fortunato et al. (1996) ArticleTitleManagement of recurrent carotid stenosis: should asymptomatic lesions be treated surgically?. J Vasc Surg 24 207–212 Occurrence Handle8752030
MA Mansour SS Kang WH Baker et al. (1997) ArticleTitleCarotid endarterectomy for recurrent stenosis. J Vasc Surg 25 877–883 Occurrence Handle1:STN:280:ByiB1MnosVI%3D Occurrence Handle9152315
BA Ballinger SR Money DM Chatman et al. (1997) ArticleTitleSites of recurrence and long-term results of redo surgery. Ann Surg 225 512–515 Occurrence Handle10.1097/00000658-199705000-00008 Occurrence Handle1:STN:280:ByiA3snkt1w%3D Occurrence Handle9193179
GP Clagett NM Rich PT McDonald et al. (1983) ArticleTitleEtiologic factors for recurrent carotid artery stenosis. Surgery 93 313–318 Occurrence Handle1:STN:280:BiyC38%2FmtlM%3D Occurrence Handle6823670
B Toursarkissian BG Rubin GA Sicard (1997) ArticleTitleRecurrent carotid artery stenosis. J Am Coll Surg 184 93–98 Occurrence Handle1:STN:280:ByiC2czivFM%3D Occurrence Handle8989308
BB Hill Ct Olcott RL Dalman et al. (1999) ArticleTitleReoperation for carotid stenosis is as safe as primary carotid endarterectomy. J Vasc Surg 30 26–35 Occurrence Handle1:STN:280:DyaK1MzisVSksw%3D%3D Occurrence Handle10394151
GS Treiman JM Jenkins WH Sr Edwards et al. (1992) ArticleTitleThe evolving surgical management of recurrent carotid stenosis. J Vasc Surg 16 354–362 Occurrence Handle10.1067/mva.1992.37939 Occurrence Handle1:STN:280:By2A1MrntFI%3D Occurrence Handle1522637
AF AbuRahma MA Choueiri (2000) ArticleTitleCranial and cervical nerve injuries after repeat carotid endarterectomy. J Vasc Surg 32 649–654 Occurrence Handle11013026
JS Yadav GS Roubin P King et al. (1996) ArticleTitleAngioplasty and stenting for restenosis after carotid endarterectomy. Initial experience. Stroke 27 2075–2079 Occurrence Handle1:STN:280:ByiD2Mvlt1Y%3D Occurrence Handle8898819
AF AbuRahma MC Bates PA Stone et al. (2001) ArticleTitleComparative study of operative treatment and percutaneous transluminal angioplasty/stenting for recurrent carotid disease. J Vasc Surg 34 831–838 Occurrence Handle10.1067/mva.2001.118591 Occurrence Handle1:STN:280:DC%2BD3Mnksl2qtg%3D%3D Occurrence Handle11700483
AR Leger M Neale JP Harris (2001) ArticleTitlePoor durability of carotid angioplasty and stenting for treatment of recurrent artery stenosis after carotid endarterectomy: an institutional experience. J Vasc Surg 33 1008–1014 Occurrence Handle10.1067/mva.2001.113485 Occurrence Handle1:STN:280:DC%2BD3Mzis1Smtg%3D%3D Occurrence Handle11331842
AP Gasecki M Eliasziw GG Ferguson et al. (1995) ArticleTitleLong-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from nascet. North American Symptomatic Carotid Endarterectomy Trial (NASCET) group. J Neurosurg 83 778–782 Occurrence Handle1:STN:280:BymD38josFw%3D Occurrence Handle7472542
GG Ferguson M Eliasziw HW Barr et al. (1999) ArticleTitleThe North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 30 1751–1758 Occurrence Handle1:STN:280:DyaK1MvgtV2hsQ%3D%3D Occurrence Handle10471419
P Locati AM Socrate G Lanza et al. (2000) ArticleTitleCarotid endarterectomy in an awake patient with contralateral carotid occlusion: influence of selective shunting. Ann Vasc Surg 14 457–462 Occurrence Handle10.1007/s100169910081 Occurrence Handle1:STN:280:DC%2BD3cvksFGqug%3D%3D Occurrence Handle10990554
JE Frawley RG Hicks LJ Gray et al. (1996) ArticleTitleCarotid endarterectomy without a shunt for symptomatic lesions associated with contralateral severe stenosis or occlusion. J Vasc Surg 23 421–427 Occurrence Handle1:STN:280:BymC1c3lt1w%3D Occurrence Handle8601883
BA Perler JF Burdick GM Williams (1992) ArticleTitleDoes contralateral internal carotid artery occlusion increase the risk of carotid endarterectomy?. J Vasc Surg 16 347–352 Occurrence Handle1:STN:280:By2A1MrntFE%3D Occurrence Handle1522636
EE Rigdon N Monajjem RS Rhodes (1997) ArticleTitleIs carotid endarterectomy justified in patients with severe chronic renal insufficiency?. Ann Vasc Surg 11 115–119 Occurrence Handle10.1007/s100169900020 Occurrence Handle1:STN:280:ByiB3sfnt1Q%3D Occurrence Handle9181764
EJ Plecha TA King HC Pitluk et al. (1993) ArticleTitleRisk assessment in patients undergoing carotid endarterectomy. Cardiovasc Surg 1 30–32 Occurrence Handle1:STN:280:ByuA2MnksFA%3D Occurrence Handle8075992
AD Hamdan FB Jr Pomposelli GW Gibbons et al. (1999) ArticleTitleRenal insufficiency and altered postoperative risk in carotid endarterectomy. J Vasc Surg 29 1006–1011 Occurrence Handle1:STN:280:DyaK1M3ovFClug%3D%3D Occurrence Handle10359934
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Domenig, C., Hamdan, A.D., Belfield, A.K. et al. Recurrent Stenosis and Contralateral Occlusion: High-risk Situations in Carotid Endarterectomy? . Ann Vasc Surg 17, 622–628 (2003). https://doi.org/10.1007/s10016-003-0068-0
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DOI: https://doi.org/10.1007/s10016-003-0068-0