The durability of carotid endarterectomy: Long-term results for restenosis and stroke

BACKGROUND:: Carotid endarterectomy is a low-risk treatment for carotid occlusive disease. Recent clinical trials have suggested that carotid angioplasty may be a viable alternative. One important issue that has not been evaluated is the long-term recurrent stenosis rate after either intervention. OBJECTIVE:: To examine the risk of recurrent stenosis after carotid endarterectomy and to provide long-term data on the durability of carotid endarterectomy. METHODS:: A total of 1335 sequential patients were followed up prospectively with annual carotid ultrasonography. All patients were maintained on antiplatelet therapy, and arteriotomies were closed with a patch graft. Operations were performed under general anesthesia with electroencephalographic monitoring and selective shunting. There were no changes in surgical technique during this study. RESULTS:: Two-thirds of the patients were men; the mean age was 70 years. Approximately 60% were symptomatic. The 90-day perioperative morbidity and mortality rate was 0.9% (0.4% stroke and 0.5% death). Five patients (0.4%) developed recurrent stenosis >70% over a mean follow-up of 15.8 years. Twelve patients (0.9%) had documentation of late stroke in the ipsilateral carotid distribution. The mean follow-up was 15.8 years. CONCLUSION:: Carotid endarterectomy is an extremely safe treatment for carotid stenosis with very low perioperative complications and low rates of recurrent stenosis or late stroke. When endarterectomy is compared with angioplasty, in addition to periprocedural complications, the durability of both interventions needs to be considered, given the risks and costs of repeat interventions. ABBREVIATIONS:: CAS, carotid artery stentingCEA, carotid endarterectomyCREST, Carotid Revascularization Endarterectomy Versus Stenting TrialICSS, International Carotid Stenting StudyNASCET, North American Symptomatic Carotid Endarterectomy Trial.