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The Etiology of Symptoms in Patients With Recurrent Carotid Stenosis

Glenn C. Hunter, MD; Julio C. Palmaz, MD; Howard H. Hayashi, MD; Carol A. Raviola, MD; Philip J. Vogt, MD; James M. Guernsey, MD
Arch Surg. 1987;122(3):311-315. doi:10.1001/archsurg.1987.01400150065013.
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• We performed 33 carotid endarterectomies in 29 patients for recurrent carotid stenosis. The interval between the initial and second operations ranged from six weeks to 11 years with a mean of 56 months. Three types of pathologic lesions were identified: (1) recurrent atherosclerosis (RA), (2) neointimal fibromuscular hyperplasia (NFH), and (3) lesions with elements of both RA and NFH (complex lesions). Histologic examination of early-recurring lesions (less than three years) revealed NFH in 17 patients and one complex lesion. Late-recurring lesions (three years or later) were due to atherosclerosis in eight vessels, NFH in four, and both RA and NFH in three. Focal neurologic symptoms occurred in 25 (76%) of 33 vessels, and an embolic source could be identified in 16 (64%) of 25 patients. Embolic events rather than reduced blood flow due to progressive stenosis are more frequent causes of symptoms in patients with recurrent carotid stenosis than was formerly believed.

(Arch Surg 1987;122:311-315)

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