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September 12, 2004
Restenosis following Carotid Endarterectomy?
 
He was a 75 year old retired professor whose days of teaching were far from over. Every medical student he was to encounter would have the opportunity to listen to his existing carotid bruits and hear the story about his bout with carotid endarterectomy (CEA). Eight years ago he underwent CEA of the left carotid artery which resulted in two major complications: a stroke that affected the contralateral side of his body, and the loss of his voice due to the laceration of a nerve during surgery. Two years later when he was undergoing CABG and aortic valve replacement, he also underwent restoration of his voice through the transplantation of cells aimed at regenerating the nerve. And now as he sat before me, I was astounded to know his history and concerned about whether this man who had already been through so much would have to go under the knife again. I was surprised to still detect a bruit in him, and wondered about the chance that his arteries would restenose to the point of requiring another round of CEA? Seems as though Ballotta et al had been wondering this too:
 
In a study spanning 13 years, 1000 patients underwent CEA by the same surgeon, and the rates of restenosis were documented. Of the 950 patients who were reassessed at an average of 6.2 years following CEA, only 0.5% of them had experienced restenosis of 70% or greater. It seems as though CEA is pretty effective in cleaning out the clogged plumbing. However, as with any other procedure encountered in medicine, CEA does not lack a list of complications that must be carefully considered by both the plumber and the owner of the pipes being cleaned. Whether this man will have to undergo surgery again is unknown, but his ability to bring to life the words “carotid bruit” from a textbook go unquestioned.
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