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International Angiology 2001 December;20(4):330-6

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: English

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


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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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