de Borst Gert J, Zanen Pieter, de Vries Jean-Paul P, van de Pavoordt Erik D, Ackerstaff Rob G, Moll Frans L
Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Vasc Surg. 2008 Feb;47(2):363-71. doi: 10.1016/j.jvs.2007.10.002. Epub 2007 Dec 26.
The role of carotid surgery for the management of restenosis after carotid endarterectomy (CEA) is challenged by carotid artery stenting (CAS). We reviewed redo CEA in a consecutive series of patients to determine the safety, durability, and long-term benefit associated with repeat surgical treatment for restenosis.
A consecutive series of 73 redo procedures in 72 patients (57% men) with a mean age 66 years (range, 49-81 years) was analyzed. The mean interval between prior CEA and redo CEA was 53 months (range, 8-192 months). Operative indications included symptomatic restenosis in 28 patients (38%). A patch angioplasty was performed in 62 patients (85%). The main outcome measures included perioperative and late stroke and death, and the development of secondary restenosis.
There were no perioperative deaths or strokes. During a mean follow-up of 52 months (range, 12-144 months), the Kaplan-Meier cumulative survival was 85% at 5 years. At 5 years, the cumulative rate of freedom from all strokes was 98%, and the freedom from ipsilateral stroke was 100%. After secondary procedures, re-recurrent stenosis > or =50% occurred in 10 patients (13.7%). The cumulative freedom from re-restenosis (> or =50%) was 85% at 5 years. Five patients (7%) received tertiary carotid reconstructions.
Repeat CEA for recurrent stenosis can be performed safely with excellent long-term protection from stroke. These data provide a standard against which the results of CAS can be compared.
颈动脉支架置入术（CAS）对颈动脉内膜切除术（CEA）后再狭窄治疗中颈动脉手术的作用提出了挑战。我们回顾了一系列连续患者的再次CEA手术，以确定与再次手术治疗再狭窄相关的安全性、耐久性和长期益处。
分析了72例患者（57%为男性）连续进行的73次再次手术，平均年龄66岁（范围49 - 81岁）。上次CEA与再次CEA之间的平均间隔为53个月（范围8 - 192个月）。手术指征包括28例（38%）有症状的再狭窄。62例患者（85%）进行了补片血管成形术。主要观察指标包括围手术期和晚期中风及死亡情况，以及继发性再狭窄的发生情况。
围手术期无死亡或中风发生。在平均52个月（范围12 - 144个月）的随访中，5年时的Kaplan - Meier累积生存率为85%。5年时，无所有中风的累积发生率为98%，同侧无中风发生率为100%。二次手术后，10例患者（13.7%）出现再发狭窄≥50%。5年时无再狭窄（≥50%）的累积发生率为85%。5例患者（7%）接受了三次颈动脉重建术。
对复发性狭窄进行再次CEA手术可安全进行，并能长期有效预防中风。这些数据提供了一个可与CAS结果进行比较的标准。
