[Restenosis and Progression of Contra-Lateral Disease after Carotid Endarterectomy. A prospective study].

OBJECTIVES

Estimate the frequency and risk factors of restenosis after carotid endarterectomy, contralateral carotid disease development, neurologic symptoms (ipsi or contralateral) and new endarterectomy (ipsi or contralateral) in patients who underwent previously endarterectomy.

METHODS

Retrospective single center analysis of the electronic clinical data and of duplex ultrasound results of 293 consecutive patients who underwent carotid endarterectomy between 2002 and 2008. The study included risk factors, procedure and patient's characteristics. All outcomes, since time-dependent, were estimated by the Kaplan-Meier method. The association between outcomes and risk factors was evaluated with the Log Rang test.

RESULTS

The proportion of patients with restenosis/occlusion during follow up was 16% (EP=0,04), at 8,5 years. The rate of patients with restenosis was much higher in patients that underwent direct closure when compared to all other (16% Vs 2% at 3,4 years; P=0,02). At 9 years, 26% (EP=0,05) of the patients without previous contralateral internal carotid artery stenosis showed progression of the disease.

CONCLUSION

Findings during duplex ultrasound follow up in patients who underwent carotid endarterectomy reach a somewhat unexpected high frequency. However, most of these changes do not mean hemodynamic or clinical significance. Direct arterial closure was associated with higher restenosis frequency. The disease progression in contralateral side occurred in a considerable proportion of cases, in particular in those patients who had already hemodynamically significant stenosis. These findings emphasize the potential benefits of duplex ultrasound follow up in patients who undergo carotid endarterectomy.