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

Introduction: 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. Case description: 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. Conclusion: 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.