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Recurrent Carotid Stenosis Due To Thrombus Formation
Pamela Kim1, George Hines2.
1Stony Brook Medicine, Stony Brook, NY, USA, 2Winthrop University Hospital, Mineola, NY, USA.

Objectives
Recurrent carotid stenosis following carotid endarterectomy is usually secondary to intimal hyperplasia or recurrent atherosclerosis. We present two patients who developed thrombus in the area of carotid repair three years after endarterectomy without prior duplex evidence of recurrent stenosis.
Methods
Both patients initially underwent uncomplicated endarterectomy with patch angioplasty and were maintained on antiplatelet therapy afterwards.

Table 1. Patients with delayed thrombus formation after carotid endarterectomy
PatientAgeSexFollowup (months)Symptomatic
6 (PSV/EDV)12 (PSV/EDV)24 (PSV/EDV)36 (PSV/EDV)YesNo
RK61female--118/34120/36360/136x
IB64male108/34--78/34370/149x

Results
Both patients underwent redo-endarterectomy and were found to have organized thrombus on the site of the endarterectomy and patch. No other obstructing lesion or aneurysmal segements were found. Repair in both patients included thrombectomy and revision of the patch. Pathology of both specimens showed thrombus.
Conclusion
Duplex evidence of recurrent high grade stenosis in a previously stable repair may be due to thrombus rather than intimal hyperplasia or recurrent atherosclerosis.


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