June 1994

Carotid Endarterectomy With Primary Closure Does Not Adversely Affect the Rate of Recurrent Stenosis

Author Affiliations

From the Section of Vascular Surgery, University of California School of Medicine—Los Angeles.

Arch Surg. 1994;129(6):648-654. doi:10.1001/archsurg.1994.01420300092016

Objectives:  To review our results with carotid endarterectomy using primary closure and to study the incidence of true recurrence in this group of patients. A secondary objective was to review the effect of risk factors on recurrence of stenosis following carotid endarterectomy.

Design:  Cohort study.

Setting:  University hospital.

Patients:  Over 3 years, 232 patients underwent 268 endarterectomies.

Indications:  Transient ischemic attacks developed in 119 patients, asymptomatic stenosis in 108 patients, and stroke in 41 patients. One hundred fifty-seven patients (184 operations) qualified for late analysis by completing all aspects of follow-up.

Outcome Measures:  Serial duplex scans recorded stenosis (>50% diameter reduction). Clinical evaluation identified transient ischemic attacks and stroke.

Results:  Overall, 12 recurrent stenoses developed in the 184 patients available for study during a follow-up of 24 months (6.5% incidence of late stenosis). Of these 12 patients, only eight had either a normal completion angiogram or a normal carotid duplex scan within 3 months of surgery, thus qualifying for analysis as having developed true recurrent stenosis. True recurrent stenosis occurred in eight (4.3%) of 184 patients. Risk factor analysis did not reveal a statistically significant impact on recurrent stenosis, but several trends were identified. Gender and consumption of tobacco may predispose toward the development of recurrent stenosis.

Conclusion:  Recurrent stenosis is sufficiently uncommon following primary closure to justify continued use of this technique. Patch angioplasty may be considered in women and smokers.(Arch Surg. 1994;129:648-654)