# Case Report: Redo carotid endarterectomy with patch angioplasty for treatment of restenosis caused by excessive intimal hyperplasia following endarterectomy: illustrative case

## TL;DR

A 69-year-old man underwent multiple surgeries for recurring carotid artery narrowing caused by intimal hyperplasia, with redo endarterectomy and patch angioplasty proving effective.

## Contribution

Presents a rare case of restenosis due to intimal hyperplasia and advocates for reCEA with patch angioplasty as an effective treatment.

## Key findings

- Restenosis from intimal hyperplasia is rare but can cause recurrent symptoms.
- Standard CEA or CAS alone may not prevent long-term restenosis in such cases.
- ReCEA with patch angioplasty is an effective treatment for this specific type of stenosis.

## Abstract

Carotid endarterectomy (CEA) is considered the surgical intervention of choice for symptomatic and asymptomatic carotid artery stenosis. Restenosis following CEA is not a rare condition. However, cases of restenosis resulting from short-term massive intimal hyperplasia of the carotid artery are relatively rare.

We present a case of a 69-year-old male patient who successively underwent carotid artery stenting (CAS), CEA and stent removal due to recurrent ischemic symptoms. Subsequently, the patient received redo carotid endarterectomy (reCEA) combined with patch angioplasty to address a third episode of carotid artery stenosis caused by extensive intimal hyperplasia. Based on a review of the relevant literature, the underlying pathological conditions and corresponding surgical strategies were analyzed and discussed.

Symptomatic restenosis caused by simple intimal hyperplasia shortly following CEA is relatively uncommon. In contrast to atherosclerotic plaques, this dense and fibrous tissue is more resistant to dissection and may lead to a reduction in vessel diameter. Neither standard CEA nor CAS alone can adequately prevent long-term restenosis. However, CEA combined with patch angioplasty has been shown to be an effective therapeutic option for this specific type of stenosis.