Clagett G P, Rich N M, McDonald P T, Salander J M, Youkey J R, Olson D W, Hutton J E
Surgery. 1983 Feb;93(2):313-8.
Since 1966, 29 patients with recurrent carotid artery stenosis have been encountered. The mean (+/- SEM) internal between initial carotid endarterectomy and secondary presentation was 67.5 +/- 9.2 months (range 6 to 180 months). There was a disproportionate number of women with recurrent stenosis. The mean age at initial endarterectomy in patients with recurrent stenosis, 54.6 +/- 1.4 years, was significantly less (P less than 0.001) than that of all patients who had endarterectomy. To define the etiologic factors for recurrence, 21 of these patients were matched with case-control patients of the same age and sex who had undergone endarterectomy the same year but did not develop recognized recurrent stenosis. There was no significant difference in the incidence of hypertension, diabetes mellitus, coronary artery disease, bilateral carotid disease, other vascular operations, or family history for atherosclerosis in patients with recurrent stenosis compared to control patients. The indications for primary endarterectomy, angiographic distribution of disease, and operative details were similar in both groups. There was no difference in the incidence of regular, therapeutic aspirin ingestion following initial endarterectomy (52.5% in both groups). There was a striking difference in smoking habits. Ninety-five percent of patients with recurrent stenosis continued to smoke following initial endarterectomy, compared to 23.8% of control patients (P less than 0.001). Lipid fractionation studies were performed in both groups, and there were no significant differences in levels of cholesterol, triglycerides, high-density lipoprotein (HDL)-cholesterol, and total cholesterol/HDL-cholesterol ratio. Dose-response platelet aggregometry detected no differences between groups in the sensitivity of platelets to adenosine diphosphate (ADP), collagen, and epinephrine. Reoperation in patients with recurrent stenosis was associated with minimal morbidity, no deaths, and generally excellent results.
自1966年以来，共遇到29例复发性颈动脉狭窄患者。初次颈动脉内膜切除术后至再次出现症状的平均（±标准误）间隔时间为67.5±9.2个月（范围6至180个月）。复发性狭窄的女性患者比例过高。复发性狭窄患者初次内膜切除术时的平均年龄为54.6±1.4岁，显著低于（P＜0.001）所有接受内膜切除术患者的平均年龄。为明确复发的病因，将其中21例患者与同年接受内膜切除术但未发生公认复发性狭窄的年龄和性别匹配的病例对照患者进行比较。与对照患者相比，复发性狭窄患者在高血压、糖尿病、冠状动脉疾病、双侧颈动脉疾病、其他血管手术或动脉粥样硬化家族史的发生率方面无显著差异。两组初次内膜切除术的指征、疾病的血管造影分布及手术细节相似。初次内膜切除术后规律服用治疗性阿司匹林的发生率在两组中无差异（均为52.5%）。吸烟习惯存在显著差异。95%的复发性狭窄患者在初次内膜切除术后继续吸烟，而对照患者中这一比例为23.8%（P＜0.001）。两组均进行了血脂分级研究，胆固醇、甘油三酯、高密度脂蛋白（HDL）胆固醇水平及总胆固醇/HDL胆固醇比值无显著差异。剂量反应血小板聚集试验未检测到两组血小板对二磷酸腺苷（ADP）、胶原和肾上腺素的敏感性存在差异。复发性狭窄患者再次手术的发病率极低，无死亡病例，且总体效果良好。
