Early Postsurgical Carotid Restenosis: Redo Surgery versus Angioplasty/Stenting

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Abstract
Purpose: To compare the results of balloon angioplasty/stenting (BA/S) versus redo surgery in patients with early carotid restenosis. Methods: Sixty-one patients (35 women; mean age 69 years, range 46–82) with early restenosis (<24 months from the primary endarterectomy) in 63 carotid arteries were treated during a 5-year period; 41 patients (41 arteries) had redo surgery (group A) and 20 patients (22 arteries) had BA/S (group B). Patients were followed regularly with duplex ultrasound to detect ≥50% recurrent restenosis (RRS) after redo surgery or BA/S. Kaplan-Meier life-table analysis was used to estimate the stroke-free survival rates and freedom from ≥50% RRS. Results: The demographic and clinical characteristics were comparable for both groups, as were the perioperative stroke and death rates (2.4% and 0% for group A, respectively, versus 4.5% and 0% for group B, p=0.46). Group A had a 12% incidence of cranial nerve injury (all transient) versus 0% for group B (p=0.11); however, group B had a higher incidence of ≥50% RRS than group A (32% versus 0%, p=0.0003). The stroke-free survival rates for redo surgery at 6, 12, 24, 36, and 48 months were 100%, 100%, 100%, 100%, and 88% versus 95%, 95%, 84%, 84%, and 63% for BA/S (p=0.067). Redo surgery had a 100% freedom from ≥50% RRS at the same time intervals, while recurrent restenosis rates for the BA/S patients were 95%, 86%, 69%, 52%, and 52% (p<0.0001). Conclusions: BA/S and redo surgery have comparable stroke and death rates in the treatment of early RCS; however, redo surgery is associated with cranial nerve injuries (transient), while stent patients have a higher incidence of recurrent lesions. These considerations should be kept in mind when selecting the appropriate treatment for patients with early postsurgical restenosis.