The evolving surgical management of recurrent carotid stenosis

Gerald S. Treiman, Judith M. Jenkins, William Edwards, William Barlow, William H. Edwards, Raymond S. Martin, Joseph L. Mulherin

    Research output: Contribution to journalArticle

    67 Citations (Scopus)

    Abstract

    The traditional approach to recurrent carotid stenosis has been repeat endarterectomy or patch angioplasty. Concern with the durability of repeat carotid endarterectomy has resulted in our use of carotid resection with autogenous graft interposition. This study was designed to determine the outcome and efficacy of carotid resection compared with repeat carotid endarterectomy in the management of recurrent carotid stenosis. From 1974 to 1991, 162 operations (repeat carotid endarterectomy 105, carotid resection 57) were performed for recurrent carotid stenosis. Indication for operation was hemispheric symptoms in 63% of patients, nonlateralizing symptoms in 25%, asymptomatic stenosis in 7%, and previous stroke in 5%. Ninety-one percent of patients had stenosis greater than 90% on arteriography. The perioperative stroke rate for carotid resection was 3.5%, with a subsequent rate of 0.0064 strokes per year. For repeat carotid endarterectomy, the perioperative stroke rate was 1.9% with a subsequent rate of 0.011 strokes per year. Graft patency after carotid resection was 93% (mean follow-up, 35 months). Four patients treated with carotid resection had graft thrombosis, and two of the four remained asymptomatic. After repeat carotid endarterectomy, one patient had carotid thrombosis, and recurrent stenosis greater than 50% developed in 23 patients (mean follow-up, 64 months). Twenty patients treated with repeat carotid endarterectomy underwent an additional operation for further symptomatic recurrent carotid stenosis. We conclude carotid resection is a safe and effective alternative to repeat carotid endarterectomy for patients undergoing operation for recurrent carotid stenosis.

    Original languageEnglish (US)
    Pages (from-to)354-362
    Number of pages9
    JournalJournal of Vascular Surgery
    Volume16
    Issue number3
    DOIs
    StatePublished - Jan 1 1992

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    Carotid Endarterectomy
    Carotid Stenosis
    Pathologic Constriction
    Stroke
    Transplants
    Carotid Artery Thrombosis
    Endarterectomy
    Angioplasty
    Angiography
    Thrombosis

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Treiman, G. S., Jenkins, J. M., Edwards, W., Barlow, W., Edwards, W. H., Martin, R. S., & Mulherin, J. L. (1992). The evolving surgical management of recurrent carotid stenosis. Journal of Vascular Surgery, 16(3), 354-362. https://doi.org/10.1016/0741-5214(92)90368-I

    The evolving surgical management of recurrent carotid stenosis. / Treiman, Gerald S.; Jenkins, Judith M.; Edwards, William; Barlow, William; Edwards, William H.; Martin, Raymond S.; Mulherin, Joseph L.

    In: Journal of Vascular Surgery, Vol. 16, No. 3, 01.01.1992, p. 354-362.

    Research output: Contribution to journalArticle

    Treiman, GS, Jenkins, JM, Edwards, W, Barlow, W, Edwards, WH, Martin, RS & Mulherin, JL 1992, 'The evolving surgical management of recurrent carotid stenosis', Journal of Vascular Surgery, vol. 16, no. 3, pp. 354-362. https://doi.org/10.1016/0741-5214(92)90368-I
    Treiman GS, Jenkins JM, Edwards W, Barlow W, Edwards WH, Martin RS et al. The evolving surgical management of recurrent carotid stenosis. Journal of Vascular Surgery. 1992 Jan 1;16(3):354-362. https://doi.org/10.1016/0741-5214(92)90368-I
    Treiman, Gerald S. ; Jenkins, Judith M. ; Edwards, William ; Barlow, William ; Edwards, William H. ; Martin, Raymond S. ; Mulherin, Joseph L. / The evolving surgical management of recurrent carotid stenosis. In: Journal of Vascular Surgery. 1992 ; Vol. 16, No. 3. pp. 354-362.
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