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Vol 7, No 2 (2005)
Published online: 2005-09-06
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Management of carotid restenosis - indications and treatment

Ryszard Staniszewski, Robert Juszkat, Michał Stanišić, Zbigniew Krasiński, Marek Winckiewicz, Wacław Majewski
Chirurgia Polska 2005;7(2):95-104.

open access

Vol 7, No 2 (2005)
Published online: 2005-09-06

Abstract

Background: The treatment of carotid restenosis after endarterectomy for atherosclerotic changes is still a major problem for vascular surgeons and interventional radiologists. There are only few publications assessing the types and methods of primary interventions and their influence on restenosis of the internal carotid artery (ICA).
Material and methods: 452 carotid endarterectomies were performed in 412 patients. Among them there were 264 male (64%) and 148 (36%) female aged from 46 to 83 years (average 69.5 ± 3.4). 427 patients underwent surgery under regional anesthesia and an intraluminar shunt was used in 48 operations. In 42 cases a PTFE patch was employed. A prospective study was designed and conducted for 386 of operated patients. The diagnosis of ICA restenosis was established according to the Duplex-Doppler examination. In the case of restenosis the indications for reintervention were evaluated and various methods of treatment were used.
Results: Restenosis above 50% was found in 52 patients (11.5%) (34 female/18 male). Restenosis 70-79% was observed also in 2 patients after PTFE patch plasty of the ICA (4.7%) - those patients were asymptomatic and remained under conservative treatment. 17 patients were qualified to reintervention (4.12%). Secondary intervention was performed within 24 months after the primary procedure in 6 patients and in 11 cases the time after the primary operation was longer than 2 years.
A reendartherectomy of the ICA was performed with the use of a PTFE patch in three patients with > 80% stenosis (2 symptomatic) - in 2 cases the changes described as intimal hyperplasia were removed. A PTA of the ICA was performed in 14 patients (among them in 7 cases asymptomatic ICA restenosis > 80% was present). In 2 patients ICA restenosis > 80% was found with concomitant occlusion of the contralateral internal carotid artery. Five patients were symptomatic. The protective Cordis Angioguard system was used as a prevention against a possible embolism. In 12 patients an angioplasty with a SMART PRECISE stent placement was performed. A WALLSTENT was implanted in 2 patients. One complication was observed (TIA) in a patient with the concomitant occlusion of ICA on contralateral side.
Conclusions: The number of patients suffering from carotid restenosis is too small to determine restricted and proved indications for secondary intervention. PTA with neuroprotection and stent placement seems to be the treatment of choice in carotid restenosis. This is a valuable method of treatment with low risk for the patients. The drawbacks are the cost of the procedure and sophisticated equipment required. Prospective randomized studies comparing the methods presented are needed to determine the indications for, and the efficacy of, each method of treatment.

Abstract

Background: The treatment of carotid restenosis after endarterectomy for atherosclerotic changes is still a major problem for vascular surgeons and interventional radiologists. There are only few publications assessing the types and methods of primary interventions and their influence on restenosis of the internal carotid artery (ICA).
Material and methods: 452 carotid endarterectomies were performed in 412 patients. Among them there were 264 male (64%) and 148 (36%) female aged from 46 to 83 years (average 69.5 ± 3.4). 427 patients underwent surgery under regional anesthesia and an intraluminar shunt was used in 48 operations. In 42 cases a PTFE patch was employed. A prospective study was designed and conducted for 386 of operated patients. The diagnosis of ICA restenosis was established according to the Duplex-Doppler examination. In the case of restenosis the indications for reintervention were evaluated and various methods of treatment were used.
Results: Restenosis above 50% was found in 52 patients (11.5%) (34 female/18 male). Restenosis 70-79% was observed also in 2 patients after PTFE patch plasty of the ICA (4.7%) - those patients were asymptomatic and remained under conservative treatment. 17 patients were qualified to reintervention (4.12%). Secondary intervention was performed within 24 months after the primary procedure in 6 patients and in 11 cases the time after the primary operation was longer than 2 years.
A reendartherectomy of the ICA was performed with the use of a PTFE patch in three patients with > 80% stenosis (2 symptomatic) - in 2 cases the changes described as intimal hyperplasia were removed. A PTA of the ICA was performed in 14 patients (among them in 7 cases asymptomatic ICA restenosis > 80% was present). In 2 patients ICA restenosis > 80% was found with concomitant occlusion of the contralateral internal carotid artery. Five patients were symptomatic. The protective Cordis Angioguard system was used as a prevention against a possible embolism. In 12 patients an angioplasty with a SMART PRECISE stent placement was performed. A WALLSTENT was implanted in 2 patients. One complication was observed (TIA) in a patient with the concomitant occlusion of ICA on contralateral side.
Conclusions: The number of patients suffering from carotid restenosis is too small to determine restricted and proved indications for secondary intervention. PTA with neuroprotection and stent placement seems to be the treatment of choice in carotid restenosis. This is a valuable method of treatment with low risk for the patients. The drawbacks are the cost of the procedure and sophisticated equipment required. Prospective randomized studies comparing the methods presented are needed to determine the indications for, and the efficacy of, each method of treatment.
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Keywords

carotid stenosis; carotid restenosis; balloon angioplasty; carotid artery desobliteration

About this article
Title

Management of carotid restenosis - indications and treatment

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 7, No 2 (2005)

Pages

95-104

Published online

2005-09-06

Bibliographic record

Chirurgia Polska 2005;7(2):95-104.

Keywords

carotid stenosis
carotid restenosis
balloon angioplasty
carotid artery desobliteration

Authors

Ryszard Staniszewski
Robert Juszkat
Michał Stanišić
Zbigniew Krasiński
Marek Winckiewicz
Wacław Majewski

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