Carotid endarterectomy (CEA) is a well-established surgical technique in stroke prophylaxis. Long-term follow-up data on restenosis or recurrent neurological symptoms in Oriental patients are unclear.
Methods:
Patients’ notes from 1994 to 2011 were retrospectively reviewed and analyzed. A total of 301 cases of CEA were identified.
Results:
A lower restenosis rate was associated with the use of patch and never smokers in both univariate and multivariate analysis. Use of patch and never smokers were also found to be significantly associated with longer restenosis-free survival. Use of patch and postoperative use of statin were associated with better overall survival in both univariate and multivariate analysis.
Conclusion:
Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.
TimaranCHManteseVAMalasM. Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the carotid revascularization endarterectomy versus stenting trial (CREST). J Vasc Surg. 2013;57(2):303–308.
2.
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American symptomatic carotid endarterectomy trial collaborators. N Engl J Med. 1991;325(7):445–453.
3.
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC european carotid surgery trial (ECST). Lancet. 1998;351(9113):1379–1387.
4.
HallidayAMansfieldAMarroJ. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363(9420):1491–1502.
5.
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273(18):1421–1428.
6.
LiSCSchoenbergBSWangCCChengXMBolisCLWangKJ. Cerebrovascular disease in the People's Republic of China: epidemiologic and clinical features. Neurology. 1985;35(12):1708–1713.
7.
Incidence of stroke in Oxfordshire: first year's experience of a community stroke register. Br Med J (Clin Res Ed). 1983;287(6394):713–717.
8.
KumarKTangKKThomasJChumponC. Review of carotid endarterectomy at Singapore general hospital. Singapore Med J. 2002;43(12):628–631.
9.
OgataTYasakaMWakugawaY. Long-term results of medical and surgical therapy for Japanese patients with moderate carotid stenosis. J Stroke Cerebrovasc Dis. 2012;21(1):24–29.
10.
SadideenHTaylorPRPadayacheeTS. Restenosis after carotid endarterectomy. Int J Clin Pract. 2006;60(12):1625–1630.
11.
TingACChengSWCheungJHoPWuLLCheungGC. Early and late outcomes in Hong Kong Chinese patients undergoing carotid endarterectomy. Chin Med J (Engl). 2002;115(4):536–539.
12.
NealeMLChambersJLKellyAT. Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American symptomatic carotid endarterectomy trial and the European carotid surgery trial. J Vasc Surg. 1994;20(4):642–649.
13.
ChengSWTingACHoPWuLL. Accelerated progression of carotid stenosis in patients with previous external neck irradiation. J Vasc Surg. 2004;39(2):409–415.
14.
HauptWFHorschS. Evoked potential monitoring in carotid surgery: a review of 994 cases. Neurology. 1992;42(4):835–838.
15.
FrericksHKievitJvan BaalenJMvan BockelJH. Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature. Stroke. 1998;29(1):244–250.
HobsonRW2ndMackeyWCAscherE. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the society for vascular surgery. J Vasc Surg. 2008;48(2):480–486.
18.
CounsellCESalinasRNaylorRWarlowCP. A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy. Eur J Vasc Endovasc Surg. 1997;13(4):345–354.
19.
BondRRerkasemKAbuRahmaAFNaylorARRothwellPM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst Rev. 2004(2):CD000160.
20.
MannheimDWellerBVahadimEKarmeliR.Carotid endarterectomy with a polyurethane patch versus primary closure: a prospective randomized study. J Vasc Surg. 2005;41(3):403–407; discussion 407-408.
21.
Al-RawiPGTurnerCLWaranVNgIKirkpatrickPJ. A randomized trial of synthetic patch versus direct primary closure in carotid endarterectomy. Neurosurgery. 2006;59(4):822–828.
22.
RerkasemKRothwellPM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst Rev. 2009(4):CD000160.
23.
ZenonosGLinNKimAKimJEGovernaleLFriedlanderRM.Carotid endarterectomy with primary closure: analysis of outcomes and review of the literature. Neurosurgery. 2012;70(3):646–654; discussion 654-655.
24.
ChanYCChengSWIrwinMG. Perioperative use of statins in noncardiac surgery. Vasc Health Risk Manag. 2008;4(1):75–81.
25.
McGirtMJPerlerBABrookeBS. 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg. 2005;42(5):829–836; discussion 836-837.
26.
LaMuragliaGMStonerMCBrewsterDC. Determinants of carotid endarterectomy anatomic durability: effects of serum lipids and lipid-lowering drugs. J Vasc Surg. 2005;41(5):762–768.
27.
KennedyJQuanHBuchanAMGhaliWAFeasbyTE. Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke. 2005;36(10):2072–2076.
28.
BrookeBSMcGirtMJWoodworthGF. Preoperative statin and diuretic use influence the presentation of patients undergoing carotid endarterectomy: results of a large single-institution case–control study. J Vasc Surg. 2007;45(2):298–303.
29.
NaylorRHayesPDPayneDA.Randomized trial of vein versus dacron patching during carotid endarterectomy: long-term results. J Vasc Surg. 2004;39(5):985–993; discussion 993.
30.
RerkasemKRothwellPM. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev. 2010(3):CD000071.
31.
LalBKBeachKWRoubinGS. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11(9):755–763.
32.
ChoJSPandurangiKConradMF. Safety and durability of redo carotid operation: an 11-year experience. J Vasc Surg. 2004;39(1):155–161.
