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Sang Thrombose Vaisseaux

Post-endarteriectomy carotid artery stenosis Volume 23, issue 10, Décembre 2011

  • Author(s): Raphael Coscas, Yves Castier, Clément Capdevila, Marc Coggia, Fabien Koskas, Olivier Goeau-Brissonniere , Hôpital Ambroise Paré, service de chirurgie vasculaire, 9 avenue Charles de Gaulle, 92104 Boulogne Cedex, France ; Faculté de Médecine Paris-Ile de France-Ouest, Université Versailles Saint Quentin en Yvelines, France, Hôpital Bichat-Claude Bernard, service de chirurgie vasculaire et thoracique, Paris, France, Hôpital de la Pitié-Salpêtrière, service de chirurgie vasculaire, Paris, France
  • Key words: Recurrent carotid stenosis, endarteriectomy, conventional surgery, endovascular therapy
  • Page(s) : 529-38
  • DOI : 10.1684/stv.2011.0656
  • Published in: 2011

Since the early 1990's, carotid endarteriectomy (CEA) has been demonstrated to be the best option to prevent stroke in cases of symptomatic and asymptomatic significant carotid stenosis. Despite excellent early results, recurrent carotid stenosis (RCS) remains a major concern during follow-up mandating long term duplex scan surveillance. RCS are usually classified as follows: immediate RCS due to a technical issue, early RCS (<18-24 months after CEA) secondary to myointimal hyperplasia, and late RCS (>18-24 months after CEA) due to atherosclerosis recurrence. Although the natural history of RCS is not well known, there is a current consensus to intervene in case of symptomatic RCS>50% and asymptomatic RCS > 80%. The optimal strategy between open surgery and endovascular therapy has not been determined due to the lack of randomized trials. Open surgery is the more durable option but it carries an increased local morbidity. This article reviews the etiologies, the diagnosis and the treatment of RCS in 2011.