Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 7-8, Pages: 528-532
https://doi.org/10.2298/SARH1208528R
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Clinical significance of internal carotid artery restenosis following carotid endarterectomy
Radak Đorđe (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Tanasković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Babić Srđan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Aleksić Nikola (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Carotid endarterectomy has been established as the preferred treatment for
symptomatic and asymptomatic high-grade carotid stenosis. Internal carotid
artery restenosis is defined as a specific entity with a great clinical
significance in carotid surgery due to accompanied increased future cerebral
ischemic events risk. Carotid restenosis is the result of neointimal
hyperplasia in the early postoperative period (within 36 months) or recurrent
atherosclerotic lesions at a later date. While the restenotic lesions caused
by neointimal hyperplasia are determined by ultrasound as smooth lesions,
atherosclerotic carotid stenosis has almost the same ultrasound and
angiographic characteristics as primary atherosclerotic lesions. Some authors
believe that patients with internal carotid artery restenosis have
insignificant risk of stroke or progression to total occlusion, and suggest
conservative treatment only. On the other hand, many surgeons have more
aggressive attitude towards the treatment of asymptomatic carotid stenosis
and indicate surgical treatment in asymptomatic patients with carotid
restenosis above 80%. The aim of our paper was to present a review of
literature available data concerning etiology, pathophysiology, clinical
significance and treatment of carotid restenosis following endarterectomy.
Numerous studies have reported satisfactory results of redo endarterectomy
and carotid angioplasty as treatment options of carotid restenosis. Carotid
angioplasty for primary atherosclerotic lesions treatment is accompanied by a
high carotid restenosis rate and therefore its role in primary carotid
symptomatic and asymptomatic stenosis treatment is still the issue of
numerous debates and the subject of extensive ongoing clinical studies
worldwide.
Keywords: restenosis, internal carotid artery, carotid endarterectomy