Sixty-three
carotid endarterectomies in 60 patients were followed by clinical and duplex scanning at 2 weeks postoperatively and at 3-monthly intervals for 3 years (mean 18 months). Four patients died (two of
stroke, two of
myocardial infarction) and four survivors had recurrent ipsilateral symptoms. Two had an immediate mild
hemiparesis which recovered completely within 36 h; in both, the endarterectomized arteries were patent on scanning. The other two experienced
amaurosis fugax for 2-3 weeks at 2 and 24 weeks; scanning showed that the sites of both
endarterectomies had become occluded. Ultrasound assessment at 2 weeks showed that 43 of 61 (70.5 per cent) endarterectomized arteries were widely patent. There were three occlusions, one
stenosis of greater than 75 per cent, three
stenoses of greater than 50 per cent and eleven
stenoses of less than 50 per cent. At 6 months a total of five vessels were occluded, with greater than 75 per cent
stenosis in three and greater than 50 per cent
stenosis in eight. At latest follow-up, six of eight arteries with greater than 50 per cent
stenosis shown earlier had scans which had reverted to normal. Tacking down of the distal intima was associated with higher incidence of restenosis and occlusion (P less than 0.01). Women were more predisposed to restenosis by neointimal
hyperplasia (P less than 0.05). All restenosis occurred within the first 6 months postoperatively (26.2 per cent) and fell to 16.4 per cent at the end of the study.