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Treatment of Recurrent Carotid Stenosis: Angioplasty with Stenting versus Reoperative Carotid Surgery

Surgical treatment of recurrent carotid stenosis (RCS) requires additional decision making as compared with the treatment of primary carotid disease. The thromboembolic risk of the lesion may vary according to the time interval from the original carotid endarterectomy to the recurrence of stenosis. Percutaneous transluminal angioplasty with stenting (PTAS) has been offered as an alternative to reoperative carotid endarterectomy (RCEA). A retrospective analysis of a computerized registry identified 43 patients who underwent treatment for 50 recurrent carotid stenoses between 1986 and 1997, 28 by PTAS and 15 by RCEA. The time interval from previous endarterectomy until secondary treatment was less than 2 years for 16 arteries (32%) and more than 2 years for 34 arteries (68%). Indications for treatment were asymptomatic high-grade stenosis in 31 patients (72.1%), transient ischemic attack (TIA) in 10 patients (25.6%), and stroke in 1 patient (2.3%). Neurologic results in the PTAS group (28) included three patients who experienced TIAs (10.7%), five patients with strokes (17.9%), but no deaths. In the RCEA group (15), no patients experienced TIAs, one patient died from a fatal stroke (6.7%), and one patient had a cranial nerve injury (6.7%). Neurologic benefit provided by PTAS for the treatment of recurrent carotid stenosis cannot be identified when compared with RCEA in this limited series.