Carotid Artery Diameters, Carotid Endarterectomy Techniques and Restenosis

Background: Restenosis of the carotid artery is a major complication of carotid endarterectomy (CEA). Thepurpose of this study was to examine the role of CEA techniques on carotid dimensions variation, postoperativeversus preoperative multi-segmental diameters and its impact on the development of restenosis at 12 months followup.Methods: 175 consecutive patients eligible for carotid surgery were included in the study. 75 underwent CEAby patch reconstruction (PR), 53 by eversion (EV) and 47 by primary closure (PC). Before the procedures andat discharge, carotid diameters were measured at four reference points (common carotid, CC; carotid bulb, CB;proximal internal carotid artery, PICA; distal internal carotid artery, DICA) by ultrasonography. The rate of minor (<50%) and major (≥ 50%) restenosis was evaluated at 12 months follow up.Results: PR produced an increase in all carotid diameters while PC and EV produced a decrease in carotiddiameters, having PC affected all diameters while EV affected CB and PICA diameter. However, postoperativediameters had comparable dimension independently of the surgical technique used. The rate of overall and majorrestenosis did not differ significantly between the three types of surgery. Logistic regression analysis showedthat female gender was associated with major restenosis (OR 6.9, 95% CI 1, 23 – 38, 49) irrespective of surgicaltechnique.Conclusion: This study shows that carotid diameters and restenosis rate after CEA are comparable whatever isthe surgical technique adopted, and that women are at high risk of major restenosis