Restenosis after Carotid Endarterectomy and Regression Following Treatment

Background: Restenosis is an important complication after carotid endarterectomy (CEA), occurring in up to 30% of patients undergoing CEA. Sporadic cases of restenosis have been reported. This study aimed to reveal the natural course of restenosis after CEA and its regression after treatment.Methods: Between January 2004 and August 2013, CEA was performed in 176 patients (190 vessels) at our hospital. Only those patients with a follow-up period of ≥6 months were included in this study. The mean postoperative follow-up period was 39.1 months (range, 6-117 months). A shunt was used in all cases, along with a patch and tacking suture in some cases (5% and 70%, respectively). All patients received antiplatelet drug therapy until the day of surgery. Restenosis was defined as >50% stenosis measured by three-dimensional computed tomography angiography or magnetic resonance angiography according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Duplex ultrasound was used to record peak systolic velocity (PSV) in the surgically treated carotid artery. A PSV of >150 cm/s was considered to indicate a stenosis of >50%, according to the NASCET criteria.Findings: Restenosis developed in 14 out of 190 vessels (8%) and occlusion in 2 (1.1%). Age was the only risk factor significantly associated with restenosis. Restenosis occurred with a significantly higher incidence in younger patients (p = 0.035). Restenosis occurred within 12 months (mean 5.3 months) in all cases. Stenosis progressed 24 months after CEA in some cases, but progression of stenosis >24 months was noted in any case. Of the 14 cases of restenosis, carotid stenting was performed in 4 cases (29%), and medications were prescribed in the remaining 10 cases (71%). In 5 cases (36%), regression was noted after a postoperative period of 30 months. The factors for regression are uncertain; however, the rate of regression increased with time.