Nostra esperienza nel trattamento chirurgico della restenosi carotidea

Background. Some aspects of the treatment of carotid restenosis are still today neither fully defined nor definitive with regard to methods and clinical results. The application of endovascular methods, increasingly frequent in particular in situations considered as "hostile" such as re-operation, has made inevitably the comparison with traditional surgical procedures. For this reason, we evaluate the current significance of surgical treatment of carotid restenoses by analysing our experience in this field. Methods. We carried out a retrospective analysis on 904 patients operated for carotid stenosis; 18 patients underwent surgery for restenosis, decided on the basis of clinical and haemodynamic evaluation independent of the time that had elapsed to onset of restenosis, and thus without limiting criteria regarding the nature of the restenosis. Results. We evaluated the type of operation performed, any aggravating factors, concomitant diseases, and the short-, medium- and long-term outcome, with particular reference to peripheral and central neurological morbidity. Conclusions. On the basis of this survey we believe that in the short-term, although the limitations of surgery with regard to peripheral neurological damage are greater than those of endovascular procedures, central neurological morbidity being equal, surgery is valid and practicable. We also believe that the long-term results are better than those of endovascular procedures, which entail a higher incidence of recurrence.