Kazmers A, Zierler R E, Huang T W, Pulliam C W, Radke H M
Vascular Surgery Service, Seattle Veterans Administration Medical Center, Washington.
Am J Surg. 1988 Nov;156(5):346-52. doi: 10.1016/s0002-9610(88)80183-1.
Fourteen patients underwent carotid reoperation for symptomatic recurrent carotid stenosis after previous ipsilateral carotid endarterectomy. Eight of these patients presented with focal transient ischemic attacks, two with strokes, and four with vertebrobasilar insufficiency. Recurrent symptoms in eight patients were similar to those prompting the initial carotid endarterectomy. Symptoms recurred early after previous carotid endarterectomy in 2 patients and late in 12 patients. Eleven patients underwent repeat endarterectomy and carotid patch angioplasty, two patients underwent patch angioplasty alone, and one patient underwent carotid artery replacement with a vein graft. Persistent or recurrent focal symptoms referable to the reoperated carotid artery were not present during follow-up (mean 27.4 months, range 4 to 79 months). Vertebrobasilar symptoms were relieved by carotid reoperation in each patient. Although the natural history of asymptomatic postoperative carotid restenosis is unknown, reluctance to reoperate on symptomatic patients is unwarranted, since carotid reoperation can be performed safely with the expectation that recurrent focal and nonfocal vertebrobasilar symptoms will be relieved.
14例患者在先前同侧颈动脉内膜切除术后因有症状的复发性颈动脉狭窄接受了颈动脉再次手术。其中8例患者出现局灶性短暂性脑缺血发作，2例出现中风，4例出现椎基底动脉供血不足。8例患者的复发症状与促使最初进行颈动脉内膜切除术的症状相似。先前颈动脉内膜切除术后，2例患者症状早期复发，12例患者症状晚期复发。11例患者接受了再次内膜切除术和颈动脉补片血管成形术，2例患者仅接受了补片血管成形术，1例患者接受了静脉移植的颈动脉置换术。随访期间（平均27.4个月，范围4至79个月）未出现与再次手术的颈动脉相关的持续性或复发性局灶性症状。颈动脉再次手术使每位患者的椎基底动脉症状得到缓解。虽然无症状术后颈动脉再狭窄的自然病程尚不清楚，但对有症状患者不愿再次手术是没有必要的，因为颈动脉再次手术可以安全进行，预期复发性局灶性和非局灶性椎基底动脉症状将得到缓解。
