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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 September;10(3):269-80

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English, Italian

Our experience with the surgical treatment of carotid restenosis

Curci R. 1, De Amicis P. 1, Felisi R. 1, Odero A. Jr. 2, Argenteri A. 2

1 Divisione di Chirurgia Vascolare, Ospedale Maggiore di Lodi, Lodi 2 Cattedra di Chirurgia Vascolare, Università degli Studi di Pavia, Pavia


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Background. Some ­aspects of the treat­ment of carot­id resten­o­sis are ­still ­today nei­ther ful­ly ­defined nor defin­i­tive ­with ­regard to meth­ods and clin­i­cal ­results. The appli­ca­tion of endo­vas­cu­lar meth­ods, increas­ing­ly fre­quent in par­tic­u­lar in sit­u­a­tions con­sid­ered as “hos­tile” ­such as re-oper­a­tion, has ­made inev­i­ta­bly the com­par­i­son ­with tra­di­tion­al sur­gi­cal pro­ce­dures. For ­this rea­son, we eval­u­ate the cur­rent sig­nif­i­cance of sur­gi­cal treat­ment of carot­id reste­nos­es by ana­lys­ing our expe­ri­ence in ­this ­field.
Methods. We car­ried out a ret­ro­spec­tive anal­y­sis on 904 ­patients oper­at­ed for carot­id sten­o­sis; 18 ­patients under­went sur­gery for resten­o­sis, decid­ed on the ­basis of clin­i­cal and hae­mod­y­nam­ic eval­u­a­tion inde­pen­dent of the ­time ­that had ­elapsed to ­onset of resten­o­sis, and ­thus with­out lim­it­ing cri­te­ria regard­ing the ­nature of the resten­o­sis.
Results. We eval­u­at­ed the ­type of oper­a­tion per­formed, any aggra­vat­ing fac­tors, con­com­i­tant dis­eas­es, and the ­short-, medi­um- and ­long-­term out­come, ­with par­tic­u­lar ref­er­ence to periph­er­al and cen­tral neu­ro­log­i­cal mor­bid­ity.
Conclusions. On the ­basis of ­this sur­vey we ­believe ­that in the ­short-­term, ­although the lim­i­ta­tions of sur­gery ­with ­regard to periph­er­al neu­ro­log­i­cal dam­age are great­er ­than ­those of endo­vas­cu­lar pro­ce­dures, cen­tral neu­ro­log­i­cal mor­bid­ity ­being ­equal, sur­gery is val­id and prac­ti­cable. We ­also ­believe ­that the ­long-­term ­results are bet­ter ­than ­those of endo­vas­cu­lar pro­ce­dures, ­which ­entail a high­er inci­dence of recur­rence.

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