Introduction:
Due to the consumption of processed food and changes in lifestyle, there has been an increase in the incidence of diseases affecting blood vessels, primarily due to fat deposition. Another reason causing the narrowing of the blood vessel is the growth of mass inside the blood vessel. Carotid endarterectomy is a surgical procedure performed to restore the proper anatomy of the blood vessel. However, even after the surgery, there can be a relapse of stenosis, termed restenosis. Therefore, suitable management approaches are chosen and restored depending on the patient's clinical situation.
What Is Carotid Endarterectomy?
The carotid artery is one of the most important blood vessels on either side of the neck that supplies to the face, brain, and neck. In carotid artery disease, a surgical procedure called carotid endarterectomy is done. Carotid artery disease causes fatty deposits to accumulate on the blood vessel's walls, narrowing it or blocking the blood supply. This surgical procedure is carried out to remove accumulated deposits, helping to restore blood supply to the brain, face, and neck.
How Is Restenosis Diagnosed?
The following methods can diagnose restenosis:
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Color-Coded Duplex Ultrasound - It is the latest diagnostic ultrasound equipment for evaluating the vascular system. It is used to assess the rate, including intracranial arteries (arteries of the brain), during the stroke and to evaluate success after any vascular surgery.
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Computed Tomography - Carotid arteries can be visualized with the help of a CT scan. A dye is injected into the bloodstream to help detect blockages. It can be used in individual pacemakers or stents too.
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Cerebral Angiography - A catheter inspects the blood vessels for any blockages. A contrast dye is injected into the blood vessel to see the detailed picture.
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Magnetic Resonance Angiography (MRA) - It is a non-invasive imaging technique similar to the computed tomography technique without using the x-rays.
What Is Restenosis After Carotid Endarterectomy?
Stenosis is a term used to describe the narrowing of the blood vessel. Carotid endarterectomy aims to remove the blocks and restore them to the artery's normal size. However, even after performing the surgery, stenosis can occur. This recurrence of stenosis in the carotid artery is called restenosis after carotid endarterectomy.
What Are the Causes of Restenosis After Carotid Endarterectomy?
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Myointimal hyperplasia (tissue reaction to the surgical intervention - scar tissue overgrowth).
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Perivascular fibrosis (stiffness of the blood vessel leading to the dysfunction of the organ supplied by it).
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Obesity (increased body weight).
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Smoking.
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High cholesterol (high content of fat in the body).
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High blood pressure.
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Repeated diagnostic procedures.
What Are the Symptoms of Restenosis After Carotid Endarterectomy?
Usually, restenosis can be asymptomatic. Symptoms like the following can occur:
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Hemorrhage (internal bleeding from a damaged blood vessel).
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Worsening headache.
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Stroke - a medical emergency due to an interruption in the brain's blood supply.
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Slurred speech.
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Loss of vision.
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Ischemic attack (temporary blockage of the blood supply to the brain).
What Is the Treatment for Restenosis After Carotid Endarterectomy?
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The first step in the management is to stop disease progression. It includes lifestyle modifications like a healthy diet, smoking cessation, and exercise. And administering medications to reduce blood pressure.
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Repeat carotid endarterectomy (removing the block in the blood vessel) based on the patient's eligibility.
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Another procedure is endovascular treatment with percutaneous transluminal angioplasty and stenting (PTAS). A certain endovascular technique used to evaluate the safety and effectiveness of the treatment is PTAS. Before this endovascular surgery, the patient is on antiplatelet treatment for three days. A catheter is introduced into the carotid artery, and a digital subtraction angiogram (an image of brain blood vessels is obtained to detect any changes in blood flow) is performed.
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Following are the materials used to maintain the blood vessel's patency preventing restenosis.
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Balloon angioplasty catheter opening up the artery to the proper size.
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Self-expanding stents can also be placed, which maintains the size of the artery.
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A sonographic evaluation after three months is performed, along with a 12-month follow-up.
What Are the Complications Associated With Restenosis After Carotid Endarterectomy?
Surgical procedures performed to restore the blood vessel's patency for recurrent restenosis after carotid endarterectomy come with technical difficulties and neurological complications; they are:
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Cerebral Embolism - Most commonly occurring stroke due to the blood clot formed in one part of the body traveling to the brain, blocking the blood supply and oxygen in the brain.
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Post-operative Wound Complications - With the incision on the skin reaching the artery, there can be a chance of developing an infection.
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Nerve Damages - Cranial nerve damage to the motor senses of the body can occur.
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Vascular Damage - Vascular damage due to blockage of the supply of oxygen, leading to tissue death and infection.
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Death - It can occur in patients with compromised immune systems with many systemic diseases, like the elderly.
What Is the Probability of Getting Restenosis After Carotid Endarterectomy?
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Degree of Previous Carotid Stenosis - The characteristics of previous carotid blocks determine the occurrence of restenosis. For example, when there is a larger block or larger degree of narrowing of the blood vessel, there are more chances of restenosis after carotid endarterectomy.
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Time Taken For the Recurrence - This parameter can be used to predict the degree of treatment outcome.
Conclusion:
In a nutshell, Carotid endarterectomy is a process to restore the normal anatomy of the carotid artery, which is blocked or narrowed (stenosed). Restenosis (recurrence of blocking or narrowing) can occur even after the surgery, followed by dangerous complications and approaches to manage the condition medically. Various diagnostic procedures and patients' clinical situations are monitored for surgical treatment. There are more severe complications associated with Restenosis After Carotid Endarterectomy. Hence, a well-experienced surgeon needs to be consulted to deal with such cases to obtain a better treatment outcome.
