Transluminal angioplasty for recurrent stenosis after carotid endarterectomy. Prognostic factors and indications.

Over a 15-month period ending in July 1992, 9 patients (7 male, 2 female; mean age 67 years) with recurrent stenosis of the internal carotid artery underwent transluminal angioplasty (TLA). The mean interval between endarterectomy and treatment of recurrent stenosis was 45 months (range: 9 to 84 months). All patients were symptomatic except one with extensive bilateral carotid dysplasia. Three patients had recurrence proximal to the endarterectomized segment (Group I); in one of these patients the narrowing was extensive. The other 6 patients (Group II) demonstrated stenoses distally. In one of these latter patients, the narrowing developed in a vein bypass. Balloon dilation was performed by the surgical route in 3 patients and percutaneously in the other 6. Perioperative transcranial Doppler (TCD) monitoring was employed in all procedures. Postoperative treatment consisted of oral Ticlopicine. In Group I (proximal recurrence), immediate complications included one case of reversible spasm and two dissections that led to acute thrombosis treated by emergency bypass and to sylvian artery embolism complicated by transient hemiplegia. In Group II (distal disease), dissection was not encountered, and only one case of transient neurologic manifestations due to cerebral edema following reperfusion was observed. Mean follow-up has been 18 months (range: 9 to 24 months). All patients are presently asymptomatic. In Group II, 2 patients presented with secondary recurrence at 6 months and were treated again by angioplasty. In one of these cases, a Palmaz stent was placed to prevent restenosis by elastic recoil.(ABSTRACT TRUNCATED AT 250 WORDS)