Abstract 19394: Restenosis after Carotid Endarterectomy: the Importance of Clinical Presentation, Type of Patch Closure and Preoperative Timing
Background: Restenosis is a drawback of carotid endarterectomy (CEA). Stable non-inflammatory atherosclerotic plaques are associated with an increased risk of restenosis. Symptomatic patients have a relatively unstable atherosclerotic plaque type. Carotid plaques stabilize over time after a cerebrovascular event, due to plaque repair after rupture. This resulted in two questions: 1 whether the type of preoperative symptomatic presentation is related to restenosis after CEA; 2. whether delayed revascularization results in a higher risk for restenosis compared to CEA on short term after a cerebrovascular event.
Methods: Between 2002 and 2009, 1203 patients were followed. The relation between clinical presentation and restenosis 1 year after CEA was investigated including analysis of CV risk factors, medication and type of arteriotomy closure. For symptomatic patients, the number of days between symptoms and CEA were gathered. A cut of value of 30 days was used to discriminate between early and delayed surgery. Patency was assessed by means of standardized duplex ultrasound at 1 year after CEA. Restenosis was defined as recurrent luminal narrowing >50% at the site of CEA.
Results: Restenosis was observed more frequently in asymptomatic patients compared to TIA and stroke patients: 23.3% (42/180) versus 13.7% (99/721) and 12.3% (37/302) respectively (P=0.002). Adjusted OR for restenosis was 0.56 [0.35–0.89] for TIA patients and 0.49 [0.27–0.87] for stroke patients as compared with asymptomatic patients. Dacron patch and primary closure were associated with an increased risk for restenosis, compared to venous patch closure with adjusted OR of 2.33 [1.52–3.58] and 2.32 [1.33–4.04] respectively. Subgroup analysis showed an increased risk for restenosis if CEA was performed more than 30 days after stroke (adjusted OR 2.23 [1.02–5.73]).
Conclusion: Asymptomatic patients have an increased risk for restenosis 1 year after CEA, compared to TIA or stroke patients. Venous patch closure appears to be superior to dacron patch and primary closure for preventing restenosis. Stroke patients operated within 30 days after the initial event have a decreased risk of restenosis. These observations support the current strategy for early surgical intervention after stroke.
- © 2010 by American Heart Association, Inc.