Results of the Early and Late Surgical Treatment of Symptomatic Carotid Stenoses Responsible for Cerebral Infarctions

and long-term results. However some patients develop a late atheromatous new stenosis apart from any healing process. The purpose of thismulticentric studywas to identify the factors of late restenosis, and the immediate and late results. Materials and Methods: Seventy carotids were operated in 67 patients (three bilateral recurrences). They were 16 women and 51 men, with a mean age of 59.77 years (46 84 years) at the time of the 1 intervention between 1983 and 2003, and 70.31 years (52 88 years) at the time of reoperation after an average delay of 10.54 years (3 24 years). The procedure for the first intervention was: a thromboendarterectomy with direct suture in 35 cases or with patch in 19 cases, an eversion in 12 cases, a bypass in three cases, and the initial technique was unknown in one case. Morbi-mortality (CRMM) was 0% and there were two regressive lesions of the hypoglossal nerve. At the time of the second intervention the technique was a thromboendarterectomy with direct suture in five cases or with patch in 22 cases, a reconstruction of the bifurcation in three cases, an eversion in four cases, and a bypass in 30 cases (16 veins and 14 prostheses), one transposition of the internal carotid in the external one and a transluminal angioplasty in five cases. In all the cases the lesions were hemodynamic atheromatous stenoses with a risk of emboli. Results: The analysis of the series showed that the development of a late atheromatous restenosis was above all related to the polyvascular diathesis (contralateral operated carotid in 13 cases, coronary surgery or dilatation in 22 cases, peripheral arterial surgery or angioplasty in 25 patients), and especially with the absence of control of the risk factors (dyslipidemia in 49 cases, hypertension in 51, and persistent active smoking in 27), with previous irradiation in one patient. The CRMM of this series of surgical redo was 4.3% with one death and two non-fatal strokes. There were five lesions of peripheral nerves including three with sequels. Later, there were two new atheromatous recurrences at 4 and 8 years. Conclusion: Late atheromatous restenoses are rare and to differentiate from the restenoses due to myointimal hyperplasia. This series showed that surgery remains a technique of choice with good performances in terms of morbimortality.