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June 1994

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

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)