doiSerbia

Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

Radak Đorđe (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd + Medicinski fakultet, Beograd)
Tanasković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd)
Vukotić Miloje (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)
Kolar Jovo (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd)
Popov Petar (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd + Medicinski fakultet, Beograd)
Nenezić Dragoslav (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd + Medicinski fakultet, Beograd)
Vučurević Goran (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd)
Gajin Predrag (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd + Medicinski fakultet, Beograd)
Ilijevski Nenad (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti „Dedinje“, Beograd + Medicinski fakultet, Beograd)

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

Keywords: restenosis, internal carotid artery, surgical treatment