Recurrent stenosis at site of carotid endarterectomy.

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Abstract
Recurrent stenosis apparently occurs in no less than 0.6% of patients after carotid endarterectomy. The pathology of the recurrent stenosis was stated in only 10 cases, indicating atherosclerotic disease in various stages of development in 7 and a fibrous intimal hyperplasia in 3. Correlation between risk factors for the development of atherosclerosis and the pathology of the recurrent diseases was poor. Six patients developed recurrent disease despite postoperative prophylactic oral anticoagulation. Surgical technique appeared to have contributed to re-stenosis in 8 patients by failure to remove the distal tongue of plaque, narrowing of the lumen by the arteriotomy suture or damage by a vascular clamp. In 18 symptomatic patients, 44% had symptoms by 3 yr, 67% by 5 yr and 83% by 7 yr after operation. The 8 patients with possible errors in surgical technique did not develop symptoms earlier than the other patients. Symptomatic patients (17) had surgical correction of the re-stenosis (endarterectomy 9, vein patch 6, arterial homograft 1, not detailed 1). The incidence of recurrent stenosis after carotid endarterectomy is low, and usually the operation provides a patent artery for life.