From the Department of Surgery, University of California at Los Angeles
School of Medicine (W.S.M.); Department of Surgery, University of Cincinnati
Medical Center (Ohio) (R.F.K.); Department of Biostatistics, University of
North Carolina, Chapel Hill, NC (J.J.N.); and Department of Neurology, Bowman
Gray School of Medicine, Winston-Salem, NC (J.F.T.).
Correspondence to Virginia J Howard, MSPH, Research Assistant Professor of Neurology, The Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1078. No reprints available.
Background and Purpose—We sought
to determine the incidence of recurrent carotid stenosis in
patients in the Asymptomatic Carotid
Atherosclerosis Study (ACAS) who had undergone carotid
endarterectomy and were prospectively followed with
Doppler ultrasound for up to 5 years.
Methods—The ACAS database was interrogated to determine the rate
of recurrent carotid stenosis (
Results—Of the 825 patients randomized to the surgical arm of the
study, 720 actually underwent carotid
endarterectomy, and 645 had complete ultrasound
data. The aggregate incidence of residual and recurrent carotid
stenosis for all time intervals ranged from 12.7% to 20.4%,
depending on the positive predictive value confidence level desired.
Residual disease occurred in 4.1% to 6.5%; true, early
restenosis was found in 7.6% to 11.4%; and late
restenosis occurred in 1.9% to 4.9%. None of the traditional
risk factors showed a statistically significant effect on recurrent
stenosis. The use of patch angioplasty closure reduced overall
risk of restenosis from 21.2% to 7.1%, from 16.7% to 4.6%,
and from 27.4% to 8.2%, depending on the PPV confidence level desired
(P<0.001). Of the 136 patients judged to have recurrent
stenosis, only 8 (5.9%) underwent reoperation (only 1 for
symptoms). There was no correlation between late stroke and recurrent
stenosis.
Conclusions—Carotid endarterectomy is a
durable procedure with a low rate of true restenosis,
particularly when patch angioplasty is used to close the arteriotomy.
© 1998 American Heart Association, Inc.
Original Contributions
Recurrent Carotid Stenosis
Results of the Asymptomatic Carotid Atherosclerosis Study
60%) based up
angiogram-validated Doppler data, with a 90% and a 95% positive
predictive value, as well as information concerning the technologists'
interpretation of percent stenosis. These 3
parameters are reported for each of 3 time intervals:
within 3 months of operation (residual disease), between 3 and 18
months (early restenoses), and between 18 and 60 months (late
restenosis).
Key Words: angioplasty • carotid endarterectomy • carotid stenosis • prospective studies
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