Conservative management of residual and recurrent lesions after carotid endarterectomy: Long-term results

Purpose: To document the natural history of residual and recurrent carotid stenoses that are initially treated without surgery, and to identify risk factors for recurrent stenosis. Methods: Review of data from a prospective carotid database with clinical and duplex follow-up. Analysis of rate of restenosis and rate of late reoperation by life table. Risk factor analysis by chi(2) and LEE-DESU statistics. Results: Three hundred forty-eight patients were available for follow-up, with 12 residual lesions (3.7%) and 22 recurrent lesions (6.6%). Rate of recurrent stenosis by life table analysis was 8.7% and 13% at 3 and 5 years. Restenosis was associated with smoking (p = 0.04) and contralateral progression. Only 21% of patients were underwent an operation within 5 years (p = 0.007) of restenosis developing, but eventually 10 of 22 patients required reoperation at long-term follow-up, eight for symptoms and two for progressive proximal stenoses. The late stroke rate was increased in patients who had residual or recurrent lesions compared with those who had normal duplex study results (18% vs 6%; p = 0.16) and was related to the ipsilateral artery. Conclusions: Recurrent lesions that remain asymptomatic can be managed without operation with Likelihood of success in the near term (5 years). However, these patients are at increased risk of late stroke, and almost half will eventually require operation. Therefore, in good-risk patients operation for asymptomatic restenoses should be considered.