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  • Title: Carotid endarterectomy with primary closure does not adversely affect the rate of recurrent stenosis.
    Author: Gelabert HA, el-Massry S, Moore WS.
    Journal: Arch Surg; 1994 Jun; 129(6):648-54. PubMed ID: 8204041.
    Abstract:
    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.
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