Carotid redo surgery: Both safe and durable

Aim: To examine the outcomes and complications of surgery for recurrent carotid stenosis. Methods: From 1974 to 2000, 1922 carotid endarterectomies were performed in our unit. A retrospective cohort analysis of these records identified 24 patients (1.2%) who underwent surgery for recurrent stenosis. Results: There were 13 men and 11 women in the group. Median follow up was 7.2 years (interquartile range 4.4-12.4 years). The indication for redo surgery was either symptomatic severe (80-99%) or moderate (50-79%) restenosis, or severe asymptomatic (80-99%) restenosis. Repair was performed by patch angioplasty (88%), endarterectomy alone (8%) or interposition grafting (4%). Within the 30 day perioperative period there were no deaths, no strokes (major or minor), or significant cardiac morbidity. One patient (4%) developed a permanent spinal accessory nerve deficit. Another patient (4%) required further re-intervention for recurrent disease. Conclusions: Very low surgical morbidity and mortality was achieved in our unit by implementing a policy of selective re-intervention for carotid restenosis. Redo carotid endarterectomy can therefore be recommended as having no greater morbidity than primary carotid endarterectomy. Carotid angioplasty and stenting are not recommended as a routine alternative treatment.