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Recurrent Stenosis is Higher after Eversion Endarterectomy
Daniel Mortensen, B.S.2, M. Ashraf Mansour, M.D.1, Robert F. Cuff, M.D.1, Christopher M. Chambers, M.D., Ph.D.1, Jason D. Slaikeu, M.D.1.
1Spectrum Health, Grand Rapids, MI, USA, 2MSU, Grand Rapids, MI, USA.

RECURRENT STENOSIS IS HIGHER AFTER EVERSION ENDARTERECTOMY
Background:
Recurrent stenosis (RCS) after carotid endarterectomy (CEA) occurs in 5-10% of cases. Redo endarterectomy or carotid stenting (CAS) are indicated in symptomatic patients or those with high-grade restenosis.
Purpose:
To review the incidence of RCS by color-flow duplex scan (CFDS), and compare the incidence after eversion and patch angioplasty CEA.
Methods:
Patients undergoing CEA were entered in a prospective database. CFDS was performed at 3, 6, 12, 24, 36, 48 months. More frequent intervals were done in select patients with abnormal results or symptoms. We excluded patients with insufficient follow-up. CFDS criteria for detecting restenosis were peak systolic of >250 cm/sec or end diastolic of >100 cm/sec. Charts were reviewed to determine what type of reintervention was performed, redo CEA or CAS.
Results:
In a 5-year period, we found 627 patients (268 women, 41%) who had CEA, 176 were eversions (28%). RCS was detected in 12 (6.8%), 8 in the first year, 3 in the second and 1 in the fourth. By comparison, 451 were CEA with patch angioplasty (72%) and 19 (4.2%) developed RCS: 8 in the first year, 7 in the second, 2 in the third and 2 in the fourth. In the eversion group, only 4 (2.2%) required CAS for symptomatic recurrence, and all 4 patients were women. There were 8 (1.8%) CAS in the patch group, 3 were women and 3 were symptomatic.
Conclusion:
This study shows that the recurrence rate with eversion endarterectomy is slightly higher than after CEA with patch angioplasty. The rate of symptomatic recurrence or RCS requiring stenting is nearly identical in both groups.


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