Endarterectomy and Restenosis

To the Editor.—We would like to thank Dr Thompson for his comments on our recent article.¹ We agree that our follow-up was short; however, a recent update of our results indicates a cumulative stroke-free survival of 97% at three years, with 65 patients having been followed up prospectively for this time period. We will continue to study this group for several years but are unable to justify prophylactic endarterectomy with these results.

As we reported, the incidence of symptomatic restenosis (1.25%) was similar to that in Dr Thompson's patients; the overall restenosis incidence was 12.5%. We would agree that a high incidence of asymptomatic restenosis is irrelevant if the inherent neurologic risk of an asymptomatic carotid stenosis is high. However, if the inherent risk is low then it is questionable whether one should perform endarterectomy when one of eight arteries is going to restenose, even if asymptomatically.