Thirteen of 1,250 patients required a second operation for recurrent
stenosis following
carotid endarterectomy performed at the Cleveland Clinic between 1958 and 1978. Two other patients underwent reoperation because of recurrent
stenosis following primary operations at other institutions. Thirteen of the 15 patients experienced
neurologic symptoms caused by recurent
stenosis, while two patients remained asymptomatic.
Atherosclerosis was responsible for recurrent
stenosis in 12 patients and appeared to be related to
hypercholesterolemia. Three of the patients had myointimal fibroplasia. Eleven of the 16 reoperations for recurrent
stenosis of the carotid artery consisted of
carotid endarterectomy with vein patch angioplasty. Three patients had
carotid endarterectomy with closure of the primary arteriotomy. One patient with occlusion of the internal carotid artery underwent
endarterectomy of the external carotid artery because of
amaurosis fugax, and a saphenous vein interposition graft was used to replace a previous
Dacron graft in one patient with anastomotic
stenosis. One patient had a
stroke during reoperation manifest as multiple
retinal emboli. Fourteen patients have remained asymptomatic from one to 70 months following reoperation. One patient with occlusion of the contralateral internal carotid artery has experienced persistent vertebrobasilar symptoms.