Risk Factors for Recurrent Carotid Artery Stenosis Following Surgical Interventions.

Dr. Makinderjit Dulai; Mr. Wael Tawfick; Ms. Niamh Hynes; Prof Sherif Sultan

Volume : VII, Issue : I, January - 2018

Risk Factors for Recurrent Carotid Artery Stenosis Following Surgical Interventions.

Dr. Makinderjit Dulai, Mr. Wael Tawfick, Ms. Niamh Hynes, Prof Sherif Sultan

Abstract :

Aims: We aim to assess restenosis rates following carotid interventions and to identify factors influencing restenosis. Primary endpoint was the incidence of restenosis and time to restenosis following carotid revascularization. Secondary endpoints included risk factors contributing to restenosis, reintervention rates, stroke and stroke free survival and overall survival.

Methods: All patients who underwent carotid repair interventions from July 2003 to May 2016 were reviewed. Patients were followed with duplex ultrasound. The Society for Vascular Surgery Carotid Reporting Standards were used as a guideline to assessment of patient demographics, risk factors and clinical presentation.

Results: Over 13 years, 9585 patients with carotid disease were referred. 690 carotid interventions were performed (633 carotid endarterectomy (CEA), 54 carotid angioplasty and stenting (CAST), 3 bypass). Restenosis occurred in 13.6% of patients (n=94). 12% occurred in the first postoperative year, 1% in the second year and 0.57% subsequently. Female gender (OR 3.051)(P<.001), contralateral stenosis (90–99%)(P=.016) and ASA grades 2 (P<.001) and 3 (P=.003) were found to be independent predictors of restenosis. There was a significant association between restenosis and hyperfiinogenaemia (OR 2.03, 95%–CI:1.26–3.27). Four restenosis patients (4.26%) required reintervention surgery, compared to 0.84% of patients without restenosis. One of the four patients who underwent redo surgery for restenosis sustained an ipsilateral stroke (1.1% of patients with restenosis) compared to 0% of the 90 restenosis patients who did not undergo surgery (P<.001).

Conclusion: Female gender, contralateral stenosis, ASA grades 2 and 3, are independent predictors of carotid restenosis. Hyperfiinogenemia and open procedures are significantly associated with higher restenosis rates. Patients who develop restenosis within the first year of surgery warrant closer follow up.