Recurrent Carotid Artery Stenosis Following Endarterectomy

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Abstract
Spectral analysis was used to examine 257 carotid arteries in 227 patients who had undergone carotid endarterectomy at 1, 3, 6 and 12 mo. after surgery and annually thereafter. Routine intraoperative completion angiography ensured that the operations were technically satisfactory. Postoperative restenoses were identified in 38 patients (15%). In 23 arteries (9%), the restenosis exceeded a 50% diameter reduction while in 15 arteries (6%) the stenosis was < 50% of the diameter. Restenosis developed in 24/96 women (25%) and 14/161 men (9%). A total of 29 (70%) stenotic lesion occurred within 12 mo. In 3 patients early lesions regressed. Reoperation with patch angioplasty was required in 6 patients. When the 219 carotid arteries that remained widely patent were compared to the 38 that restenosed, smoking or degree of preoperative stenosis. Early stenotic lesions appear to be due to myointimal hyperplasia, which is probably platelet mediated. The predominant female sex distribution may be explained by differences in platelet responsiveness in men and women.