Secondary recurrent carotid stenosis

D. Rosenthal, Jr Archie J.P., M. H. Avila, D. F. Bandyk, J. D. Carmichael, G. P. Clagett, J. L. Hamman, H. M. Lee, P. R. Liebman, Joseph L Mills, S. L. Minken, G. W. Plonk, M. P. Posner, R. B. Smith, S. T. String, Sr Edwards W.H.

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Purpose: Recurrent carotid stenosis after carotid endarterectomy has been extensively reported. The occurrence, however, of another ipsilateral restenosis that requires a third carotid operation is rare. The purpose of this study was to evaluate possible risk factors and the most efficacious management of the patient with 'secondary' recurrent carotid stenosis. Method: A survey of the Southern Association for Vascular Surgery was performed, and 31 patients who had had surgery for secondary recurrent carotid stenosis were identified. Results: The mean interval between the recurrent stenosis operation and secondary recurrent carotid stenosis was 39.8 months (range, 9 to 83 months). At the third operation, 21 patients underwent carotid patch angioplasty and 10 underwent carotid resection with an interposition saphenous vein graft. No postoperative strokes or deaths occurred; three patients (10%) had a peripheral nerve injury. Nine early (<24 mo) secondary recurrent carotid stenoses occurred, and these patients underwent patch angioplasty. Twenty-three female, cigarette-smoking patients and 20 patients with elevated lipid levels had early restenosis and were identified as being at high risk for the development of another stenosis. A fourth significant stenosis developed in five of these high-risk patients who had saphenous vein patch angioplasty at their third carotid operation; eight other high-risk patients had carotid resection with an interposition saphenous vein graft, and no other stenosis developed. Conclusion: Patients who have secondary recurrent carotid stenoses can safely undergo a third carotid operation. Female habitual smokers with elevated lipid levels and an early restenosis appear to be at high risk of secondary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more durable than patch angioplasty.

Original languageEnglish (US)
Pages (from-to)424-429
Number of pages6
JournalJournal of Vascular Surgery
Volume24
Issue number3
DOIs
StatePublished - 1996
Externally publishedYes

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Carotid Stenosis
Saphenous Vein
Angioplasty
Pathologic Constriction
Transplants
Lipids
Peripheral Nerve Injuries
Carotid Endarterectomy
Smoking
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Rosenthal, D., Archie J.P., J., Avila, M. H., Bandyk, D. F., Carmichael, J. D., Clagett, G. P., ... Edwards W.H., S. (1996). Secondary recurrent carotid stenosis. Journal of Vascular Surgery, 24(3), 424-429. https://doi.org/10.1016/S0741-5214(96)70198-2

Secondary recurrent carotid stenosis. / Rosenthal, D.; Archie J.P., Jr; Avila, M. H.; Bandyk, D. F.; Carmichael, J. D.; Clagett, G. P.; Hamman, J. L.; Lee, H. M.; Liebman, P. R.; Mills, Joseph L; Minken, S. L.; Plonk, G. W.; Posner, M. P.; Smith, R. B.; String, S. T.; Edwards W.H., Sr.

In: Journal of Vascular Surgery, Vol. 24, No. 3, 1996, p. 424-429.

Research output: Contribution to journalArticle

Rosenthal, D, Archie J.P., J, Avila, MH, Bandyk, DF, Carmichael, JD, Clagett, GP, Hamman, JL, Lee, HM, Liebman, PR, Mills, JL, Minken, SL, Plonk, GW, Posner, MP, Smith, RB, String, ST & Edwards W.H., S 1996, 'Secondary recurrent carotid stenosis', Journal of Vascular Surgery, vol. 24, no. 3, pp. 424-429. https://doi.org/10.1016/S0741-5214(96)70198-2
Rosenthal D, Archie J.P. J, Avila MH, Bandyk DF, Carmichael JD, Clagett GP et al. Secondary recurrent carotid stenosis. Journal of Vascular Surgery. 1996;24(3):424-429. https://doi.org/10.1016/S0741-5214(96)70198-2
Rosenthal, D. ; Archie J.P., Jr ; Avila, M. H. ; Bandyk, D. F. ; Carmichael, J. D. ; Clagett, G. P. ; Hamman, J. L. ; Lee, H. M. ; Liebman, P. R. ; Mills, Joseph L ; Minken, S. L. ; Plonk, G. W. ; Posner, M. P. ; Smith, R. B. ; String, S. T. ; Edwards W.H., Sr. / Secondary recurrent carotid stenosis. In: Journal of Vascular Surgery. 1996 ; Vol. 24, No. 3. pp. 424-429.
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abstract = "Purpose: Recurrent carotid stenosis after carotid endarterectomy has been extensively reported. The occurrence, however, of another ipsilateral restenosis that requires a third carotid operation is rare. The purpose of this study was to evaluate possible risk factors and the most efficacious management of the patient with 'secondary' recurrent carotid stenosis. Method: A survey of the Southern Association for Vascular Surgery was performed, and 31 patients who had had surgery for secondary recurrent carotid stenosis were identified. Results: The mean interval between the recurrent stenosis operation and secondary recurrent carotid stenosis was 39.8 months (range, 9 to 83 months). At the third operation, 21 patients underwent carotid patch angioplasty and 10 underwent carotid resection with an interposition saphenous vein graft. No postoperative strokes or deaths occurred; three patients (10{\%}) had a peripheral nerve injury. Nine early (<24 mo) secondary recurrent carotid stenoses occurred, and these patients underwent patch angioplasty. Twenty-three female, cigarette-smoking patients and 20 patients with elevated lipid levels had early restenosis and were identified as being at high risk for the development of another stenosis. A fourth significant stenosis developed in five of these high-risk patients who had saphenous vein patch angioplasty at their third carotid operation; eight other high-risk patients had carotid resection with an interposition saphenous vein graft, and no other stenosis developed. Conclusion: Patients who have secondary recurrent carotid stenoses can safely undergo a third carotid operation. Female habitual smokers with elevated lipid levels and an early restenosis appear to be at high risk of secondary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more durable than patch angioplasty.",
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T1 - Secondary recurrent carotid stenosis

AU - Rosenthal, D.

AU - Archie J.P., Jr

AU - Avila, M. H.

AU - Bandyk, D. F.

AU - Carmichael, J. D.

AU - Clagett, G. P.

AU - Hamman, J. L.

AU - Lee, H. M.

AU - Liebman, P. R.

AU - Mills, Joseph L

AU - Minken, S. L.

AU - Plonk, G. W.

AU - Posner, M. P.

AU - Smith, R. B.

AU - String, S. T.

AU - Edwards W.H., Sr

PY - 1996

Y1 - 1996

N2 - Purpose: Recurrent carotid stenosis after carotid endarterectomy has been extensively reported. The occurrence, however, of another ipsilateral restenosis that requires a third carotid operation is rare. The purpose of this study was to evaluate possible risk factors and the most efficacious management of the patient with 'secondary' recurrent carotid stenosis. Method: A survey of the Southern Association for Vascular Surgery was performed, and 31 patients who had had surgery for secondary recurrent carotid stenosis were identified. Results: The mean interval between the recurrent stenosis operation and secondary recurrent carotid stenosis was 39.8 months (range, 9 to 83 months). At the third operation, 21 patients underwent carotid patch angioplasty and 10 underwent carotid resection with an interposition saphenous vein graft. No postoperative strokes or deaths occurred; three patients (10%) had a peripheral nerve injury. Nine early (<24 mo) secondary recurrent carotid stenoses occurred, and these patients underwent patch angioplasty. Twenty-three female, cigarette-smoking patients and 20 patients with elevated lipid levels had early restenosis and were identified as being at high risk for the development of another stenosis. A fourth significant stenosis developed in five of these high-risk patients who had saphenous vein patch angioplasty at their third carotid operation; eight other high-risk patients had carotid resection with an interposition saphenous vein graft, and no other stenosis developed. Conclusion: Patients who have secondary recurrent carotid stenoses can safely undergo a third carotid operation. Female habitual smokers with elevated lipid levels and an early restenosis appear to be at high risk of secondary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more durable than patch angioplasty.

AB - Purpose: Recurrent carotid stenosis after carotid endarterectomy has been extensively reported. The occurrence, however, of another ipsilateral restenosis that requires a third carotid operation is rare. The purpose of this study was to evaluate possible risk factors and the most efficacious management of the patient with 'secondary' recurrent carotid stenosis. Method: A survey of the Southern Association for Vascular Surgery was performed, and 31 patients who had had surgery for secondary recurrent carotid stenosis were identified. Results: The mean interval between the recurrent stenosis operation and secondary recurrent carotid stenosis was 39.8 months (range, 9 to 83 months). At the third operation, 21 patients underwent carotid patch angioplasty and 10 underwent carotid resection with an interposition saphenous vein graft. No postoperative strokes or deaths occurred; three patients (10%) had a peripheral nerve injury. Nine early (<24 mo) secondary recurrent carotid stenoses occurred, and these patients underwent patch angioplasty. Twenty-three female, cigarette-smoking patients and 20 patients with elevated lipid levels had early restenosis and were identified as being at high risk for the development of another stenosis. A fourth significant stenosis developed in five of these high-risk patients who had saphenous vein patch angioplasty at their third carotid operation; eight other high-risk patients had carotid resection with an interposition saphenous vein graft, and no other stenosis developed. Conclusion: Patients who have secondary recurrent carotid stenoses can safely undergo a third carotid operation. Female habitual smokers with elevated lipid levels and an early restenosis appear to be at high risk of secondary recurrent carotid stenoses. When surgery is necessary, carotid resection with an interposition saphenous vein graft appears more durable than patch angioplasty.

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