Restenosis after carotid endarterectomy: significance of newly acquired risk factors

Eur J Neurol. 2010 Mar;17(3):493-8. doi: 10.1111/j.1468-1331.2009.02858.x. Epub 2009 Nov 18.

Abstract

Background: In patients who had carotid endarterectomy (CEA), the significance of newly acquired cerebrovascular risk factors (CRFs) is unknown. Newly acquired CRFs are defined as CRFs not present prior to CEA (baseline CRFs) but acquired during long-term follow-up.

Objective: We sought to determine the significance of newly acquired CRFs in CEA patients with regard to progressive ICA disease (> or =50% restenosis; occurrence or progression of contralateral stenosis).

Methods: In a single-center CEA-registry, 361 CEA patients with annual follow-up visits for 7 years were identified. Hazard ratios (HR) were calculated for (i) any baseline CRF (hypertension, diabetes, hypercholesterolemia, coronary heart disease (CHD), peripheral artery disease (PAD), smoking), (ii) any newly acquired CRF, and (iii) for the use of statins and antihypertensives.

Results: No baseline CRF was associated with progressive ICA disease (unadjusted analysis). After adjustment for age and gender, smoking (HR 1.52, 95%CI 1.02-2.26), diabetes (HR 1.64, 95%CI 1.00-2.68), and hypercholesterolemia (HR 1.61, 95%CI 1.03-2.52) were weakly related to progressive ICA disease. Newly acquired hypertension (HR 2.44, 95%CI 1.57-3.79), CHD (HR 2.73, 95%CI 1.81-4.11), diabetes (HR 2.30, 95%CI 1.39-3.80), and PAD (HR 3.94, 95%CI 2.69-5.76) were associated with progressive ICA disease; also, after adjustment for baseline CRFs. Acquisition of at least one new CRF was related to progressive ICA disease (HR(adjusted) 8.07, 95%CI 4.97-13.12). Neither statins nor antihypertensive drugs did alter the odds for progressive ICA disease.

Conclusion: CRFs acquired during long-term follow-up after CEA may independently contribute to progressive ICA stenosis after endarterectomy. Newly acquired CRFs might be more hazardous than CRFs present prior to CEA.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carotid Stenosis / drug therapy
  • Carotid Stenosis / epidemiology
  • Carotid Stenosis / etiology*
  • Carotid Stenosis / surgery*
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / drug therapy
  • Disease Progression
  • Endarterectomy, Carotid* / adverse effects
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Registries
  • Risk Factors
  • Time Factors