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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2001 December;20(4):330-6


lingua: Inglese

Recurrent carotid artery stenosis: natural history and predisposing factors. A long-term follow-up study

Liapis C. D., Kakisis J. D., Kostakis A. G.

From the 2nd Department of Propedeutic Surgery, Athens University Medical School, Laiko Hospital, Athens, Greece


Background. The aim of this study was to eval­u­ate the ­impact of var­i­ous risk fac­tors, exclud­ing the type of clo­sure of the arter­i­ot­o­my, on the devel­op­ment of recur­rent carot­id sten­o­sis after carot­id endar­te­rec­to­my. Type of study: sin­gle-cen­ter, open pros­pec­tive.
Methods. Three hun­dred and eight ­patients, who under­went a total of 338 carot­id endar­te­rec­to­mies, were eval­u­at­ed post­op­er­a­tive­ly with color ­duplex 1 month after the oper­a­tion and every 6 ­months there­af­ter, the mean dura­tion of fol­low-up being 52 ­months (range: 6-144). Only ­patients sub­mit­ted to pri­mary clo­sure of the arter­i­ot­o­my were includ­ed. Statistical anal­y­sis was per­formed using the Kaplan Meier meth­od, the log rank test and Cox regres­sion anal­y­sis.
Results. Three ­patients (0.9%) died dur­ing the per­i­op­er­a­tive peri­od. Three (0.9%) ­patients had a tran­sient ischem­ic ­attack and 7 (2.1%) a non­fa­tal ­stroke. Recurrent carot­id sten­o­sis of >50% was iden­ti­fied in 11 ­patients, lead­ing to a 21.6% cumu­la­tive resten­o­sis rate at 10 years of fol­low-up. Only one of the 11 ­patients with resten­o­sis devel­oped neu­ro­log­i­cal symp­toms dur­ing the fol­low-up peri­od. Both uni­var­i­ate and mul­ti­var­i­ate anal­y­ses ­showed that cor­o­nary ­artery dis­ease was sig­nif­i­cant­ly asso­ciat­ed with resten­o­sis, while ­patients with uni­form­ly ech­o­gen­ic ­plaques as well as those with hyper­cho­les­ter­o­le­mia ­showed a lower inci­dence of resten­o­sis.
Conclusions. The cumu­la­tive recur­rent sten­o­sis rate fol­low­ing carot­id endar­te­rec­to­my was 21.6% at 10 years of fol­low-up. Restenosis was symp­to­mat­ic in 1 ­patient. Coronary ­artery dis­ease was asso­ciat­ed with an ­increased risk of resten­o­sis, while uni­form­ly ech­o­gen­ic ­plaques and hyper­cho­les­ter­o­le­mia were asso­ciat­ed with a lower risk.

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