Temporal Shrinkage of the Carotid Artery after Carotid Endarterectomy

Abstract

To further characterize early restenosis after carotid endarterectomy (CEA), we reviewed 40 cases of consecutive CEA treatments followed by serial carotid plaque black-blood magnetic resonance imaging (BB-MRI). Restenosis developed in seven (18%) cases at intervals of 6 months to 2 years. None of the cases demonstrated vascular wall thickness indicative of myointimal hyperplasia; however, outer-diameter narrowing (8–35%) of the carotid artery was evident, which improved gradually without any clinical events. This temporal shrinkage was associated non-significantly with the pre-surgical degree of stenosis, high calcification, or hemodynamic insufficiency. Unlike the progressive arterial shrinkage from attenuation of the media in Moyamoya disease or coarctation of the aorta, intensive damage and recovery of the carotid artery media may result in temporal shrinkage. To our knowledge, this is the first report of a decrease in the outer-diameter of the carotid artery after CEA. Given our limited number of cases, further studies are warranted to enhance our understanding of the pathophysiology of post-CEA carotid artery temporal shrinkage.