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Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy

Author

Listed:
  • Raluca Niculescu

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
    These authors contributed equally to this work.)

  • Eliza Russu

    (Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
    Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
    These authors contributed equally to this work.)

  • Emil Marian Arbănași

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania)

  • Réka Kaller

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania)

  • Eliza Mihaela Arbănași

    (Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania)

  • Răzvan Marian Melinte

    (Department of Orthopedics, Regina Maria Health Network, 540098 Targu Mures, Romania
    Department of Orthopedics, Humanitas MedLife Hospital, 400664 Cluj Napoca, Romania)

  • Cătălin Mircea Coșarcă

    (Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania)

  • Iuliu Gabriel Cocuz

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania)

  • Adrian Horațiu Sabău

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania)

  • Andreea Cătălina Tinca

    (Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
    Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania)

  • Adina Stoian

    (Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania)

  • Vlad Vunvulea

    (Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania)

  • Adrian Vasile Mureșan

    (Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
    Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139, Targu Mures, Romania
    These authors contributed equally to this work.)

  • Ovidiu Simion Cotoi

    (Department of Pathology, Mures Clinical County Hospital, 540011 Targu Mures, Romania
    Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
    These authors contributed equally to this work.)

Abstract

Background: Carotid endarterectomy (CEA) is the first-line surgical intervention for cases of severe carotid stenoses. Unfortunately, the restenosis rate is high after CEA. This study aims to demonstrate the predictive role of carotid plaque features and inflammatory biomarkers (monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in carotid restenosis and mortality at 12 months following CEA. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a minimum of 70% carotid stenosis and surgical indications for CEA admitted to the Vascular Surgery Clinic, Emergency County Hospital of Targu Mures, Romania between 2018 and 2021. Results: According to our results, the high pre-operative values of inflammatory biomarkers—MLR (OR: 10.37 and OR: 6.11; p < 0.001), NLR (OR: 34.22 and OR: 37.62; p < 0.001), PLR (OR: 12.02 and OR: 16.06; p < 0.001), SII (OR: 18.11 and OR: 31.70; p < 0.001), SIRI (OR: 16.64 and OR: 9.89; p < 0.001), and AISI (OR: 16.80 and OR: 8.24; p < 0.001)—are strong independent factors predicting the risk of 12-month restenosis and mortality following CEA. Moreover, unstable plaque (OR: 2.83, p < 0.001 and OR: 2.40, p = 0.04) and MI (OR: 3.16, p < 0.001 and OR: 2.83, p = 0.005) were independent predictors of all outcomes. Furthermore, AH (OR: 2.30; p = 0.006), AF (OR: 1.74; p = 0.02), tobacco (OR: 2.25; p < 0.001), obesity (OR: 1.90; p = 0.02), and thrombotic plaques (OR: 2.77; p < 0.001) were all independent predictors of restenosis, but not for mortality in all patients. In contrast, antiplatelet (OR: 0.46; p = 0.004), statin (OR: 0.59; p = 0.04), and ezetimibe (OR:0.45; p = 0.03) therapy were protective factors against restenosis, but not for mortality. Conclusions: Our data revealed that higher preoperative inflammatory biomarker values highly predict 12-month restenosis and mortality following CEA. Furthermore, age above 70, unstable plaque, cardiovascular disease, and dyslipidemia were risk factors for all outcomes. Additionally, AH, AF, smoking, and obesity were all independent predictors of restenosis but not of mortality in all patients. Antiplatelet and statin medication, on the other hand, were protective against restenosis but not against mortality.

Suggested Citation

  • Raluca Niculescu & Eliza Russu & Emil Marian Arbănași & Réka Kaller & Eliza Mihaela Arbănași & Răzvan Marian Melinte & Cătălin Mircea Coșarcă & Iuliu Gabriel Cocuz & Adrian Horațiu Sabău & Andreea Căt, 2022. "Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy," IJERPH, MDPI, vol. 19(21), pages 1-14, October.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:21:p:13934-:d:954203
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    References listed on IDEAS

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    1. Peter Libby, 2002. "Inflammation in atherosclerosis," Nature, Nature, vol. 420(6917), pages 868-874, December.
    2. Nicoletta Brunelli & Claudia Altamura & Carmelina Maria Costa & Riccardo Altavilla & Paola Palazzo & Paola Maggio & Marilena Marcosano & Fabrizio Vernieri, 2022. "Carotid Artery Plaque Progression: Proposal of a New Predictive Score and Role of Carotid Intima-Media Thickness," IJERPH, MDPI, vol. 19(2), pages 1-8, January.
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    Cited by:

    1. Eliza Russu & Adrian Vasile Mureșan & Adrian Dumitru Ivănescu & Réka Kaller & Daniela Elena Nedelea & Raluca Niculescu & Bogdan Andrei Cordoș & Ovidiu Aurelian Budișcă & Eliza Mihaela Arbănași & Emil , 2023. "Polytetrafluorethylene (PTFE) vs. Polyester (Dacron ® ) Grafts in Critical Limb Ischemia Salvage," IJERPH, MDPI, vol. 20(2), pages 1-13, January.
    2. Min-Su Kim & Min Young Heo & Hyo Jin Joo & Ga Yang Shim & Jinmann Chon & Sung Joon Chung & Yunsoo Soh & Myung Chul Yoo, 2023. "Neutrophil-to-Lymphocyte Ratio as a Predictor of Short-Term Functional Outcomes in Acute Ischemic Stroke Patients," IJERPH, MDPI, vol. 20(2), pages 1-12, January.
    3. Danka Vukašinović & Miloš Maksimović & Slobodan Tanasković & Jelena M. Marinković & Đorđe Radak & Jadranka Maksimović & Isidora Vujčić & Nebojša Prijović & Hristina Vlajinac, 2023. "Body Mass Index and Late Adverse Outcomes after a Carotid Endarterectomy," IJERPH, MDPI, vol. 20(3), pages 1-10, February.

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