Carotid endarterectomy with reimplantation of the internal carotid artery: perioperative risk, and incidence of recurrent stenosis in 167 procedures.

Between 1990-1998, 167 carotid endarterectomies with reimplantation were performed on 153 patients. Indications for operation were asymptomatic stenosis >60% (50.2%), transient ischemic attacks (17. 4%), amaurosis fugax (14.4%) and previous stroke (18%). Our method involves transection of the internal carotid artery at its origin, standard endarterectomy without any eversion maneuver and reimplantation. Our results showed one postoperative stroke, which occurred at the contralateral side and no deaths with an overall perioperative morbidity and mortality rate of 0.59%. In addition, two (1.19%) transient ischemic attacks and one (0.59%) temporary ataxic event were noted with complete resolution of the symptoms. The 5-yr primary patency rate was 96% with a 95% 5-yr freedom from ipsilateral stroke. The mean follow up period was 22 months. In conclusion, we believe that our method, is relatively easy to perform, it has excellent results and it eliminates some of the disadvantages associated with the eversion technique.