Is the incidence of recurrent carotid artery stenosis influenced by the choice of the surgical technique? Carotid endarterectomy versus saphenous vein bypass

Abstract

Purpose: The purpose of this study is to compare the incidence of recurrent carotid artery stenosis (RCS) after carotid endartarectomy (CEA) and saphenous vein grafting (SVG) in patients with bilateral carotid artery stenosis.

Methods: Between 1978 and 1990, 1483 patients underwent carotid artery surgery at our institution. Fifty-one patients were diagnosed with bilateral carotid artery stenosis and were included in a prospective study that consisted of performance of CEA on one side and SVG on the other. The patients consisted of 34 men and 17 women. Forty patients had symptoms, and 11 were symptom free with severe (> or = 90%) bilateral carotid artery stenosis. All patients underwent a two-stage procedure with an operative interval that ranged from 5 days to 6 months.

Results: All patients survived, and no permanent postoperative neurologic deficit was observed. Follow-up was available for all patients and ranged from 6 to 150 months (mean 52 months). Serial Doppler studies were performed in all patients at 6- to 9-month intervals. Unilateral RCS (> or = 80%) occurred in two cases (two of 102); one in a CEA (one of 51) and one in the distal anastomosis of a SVG (one of 51) at 6 and 8 months, respectively, after operation. The reoperative surgical technique performed in both cases was a SVG.

Conclusions: The incidence of RCS requiring repeat operation after carotid artery surgery is not influenced by the choice of the surgical technique, namely CEA or saphenous vein bypass.