The influence of smoking and lipids on restenosis after carotid endarterectomy

Cuming, R.; Worrell, P.; Woolcock, N.E.; Franks, Peter J.; Greenhalgh, Roger M.; Powell, J.T.

doi:10.1016/s0950-821x(05)80372-x

Cited by 35 publications

(14 citation statements)

References 15 publications

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“…The following risk factors have been found to be significant for restenosis: younger age [5], female [1, 5, 8], preoperative symptomatic disease [6, 18], smoking [1, 11, 19], diabetes (risk or protective) [5, 20], hyperlipidemia [4], and hypertension [2]. With the exception of smoking, risk factors were considered currently positive if diagnosed or treated at any time.…”

Section: Methodsmentioning

confidence: 99%

Significance of Carotid Restenosis following Endarterectomy

Ganesan¹,

Côté²,

Mackey³

1998

Cerebrovasc Dis

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Background and Purpose: The clinical significance of restenosis after carotid endarterectomy as detected by duplex ultrasound has not been clearly established. To address this problem, we retrospectively evaluated the experience at two university-affiliated hospitals. Methods: All charts of patients with carotid endarterectomies between June 1987 and April 1995 were reviewed. Inclusion required neurological assessment and postoperative duplex ultrasound. Exclusion was based on a known source of cardioembolic disease, or recent (<6 months) myocardial infarction. Primary clinical endpoints were ipsilateral transient ischemic attack (TIA) or ischemic stroke. Contributing vascular risk factors were also identified. The effect of restenosis on event-free survival was analyzed using life tables and Gehan-Wilcoxon rank sum tet. Logistic regression was used to identify independent risk factors for restenosis and vascular events. Results: One hundred and eighty-seven patients were identified who underwent a total of 207 endarterectomies. Mean follow-up was 30.4 ± 20.9 months during which a total of 64 vascular events, including 42 TIAs, 18 strokes, and 4 vascular deaths occurred. Of these 21 TIAs and 8 strokes were ipsilateral to the side of endarterectomy. Event rates were compared for patients with ipsilateral high- (≥50%) and low-grade (<50%) restenosis. These two groups were comparable in terms of baseline risk factors. There was no significant difference in vascular event rates (for either ipsilateral events or events in any vascular territory) between the group with high- and low-grade restenosis. Nor was any such difference in event rates shown for patients who showed ipsilateral progression of carotid disease on serial ultrasound. However, patients operated for symptomatic carotid disease had a significantly higher risk of neurological events (p = 0.035). Logistic regression failed to disclose any other risk factors that were independently predictive of either restenosis or vascular events during follow-up. Conclusion: This study does not show a difference in vascular event rates for higher grades of carotid restenosis after carotid endarterectomy. Routine surveillance with carotid ultrasound does not appear to identify patients at higher risk for postoperative cerebrovascular events.

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Section: Methodsmentioning

confidence: 99%

Significance of Carotid Restenosis following Endarterectomy

Ganesan¹,

Côté²,

Mackey³

1998

Cerebrovasc Dis

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“…The main points of the remaining 10 articles are summarized in Table 3. The study by Cuming et al 18 was excluded from calculations because the number of ipsilateral strokes is zero in both the restenosis and no restenosis groups.…”

Section: Relative Risk Of Ipsilateral Stroke In Patients With Restenosismentioning

confidence: 99%

Carotid Recurrent Stenosis and Risk of Ipsilateral Stroke

Frericks

Kievit

Baalen

et al. 1998

Stroke

181

108

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Background-The main goal of follow-up after carotid endarterectomy is to prevent new strokes caused by recurrent stenosis.To determine the most cost-effective follow-up schedule, it is necessary to know the incidence of recurrent stenosis and the risk of stroke it carries. Methods-A systematic review of the literature was performed using standard meta-analytical techniques. Results-Incidence of recurrent stenosis: The data were very heterogeneous. The risk of recurrent stenosis was 10% in the first year, 3% in the second, and 2% in the third. Long-term risk of recurrent stenosis is about 1% per year. Risk of stroke: The reported relative risks of stroke in patients with recurrent stenosis compared with patients without recurrent stenosis showed extreme heterogeneity and ranged from 10 to 0.10. The random effects summary estimator of relative risk was 1.88. Conclusions-The data were very heterogeneous, and much better data are needed to arrive at truly reliable estimates of these important parameters of follow-up. It is clear, though, that the risk of recurrent stenosis is highest in the first few years after carotid endarterectomy and very low in later years. By use of general decision-analytic arguments, it can be argued that, given the test characteristics of carotid ultrasound, a small number of tests can be done in the first few years and that testing for restenosis should not be done after 4 years. (Stroke. 1998;29:244-250.)

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“…Some studies have shown that continued smoking following CEA is a risk factor for restenosis, 29 whereas others have not shown this relationship. 2,30 Because smokers have repeatedly been shown to have lower vitamin C levels, [31][32][33][34] it may be contributory to the higher restenosis rate in smokers.…”

Section: Discussionmentioning

confidence: 99%

Decreased Antioxidant Vitamin Concentration May Be a Risk Factor for Recurrent Carotid Stenosis

Reid

Lau

Hannon

et al. 2007

Vasc Endovascular Surg

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Carotid endarterectomy has been found to be associated with a transient increase in systemic oxidative stress, and this has been shown to be a predictor of restenosis. The aim of this study was to determine the incidence of early recurrent stenosis and investigate a possible role of oxidative stress in its development by measuring the concentration of antioxidant vitamins. Patients undergoing carotid endarterectomy between August 2001 and February 2003 were included in the study. A preoperative blood sample was analyzed for antioxidant vitamin concentrations. All patients were followed up by duplex scans 3 and 12 months postoperatively. Ninety-three patients (101 carotid endarterectomies) were recruited. Nine arteries had developed restenosis by 12 months. Those patients who developed recurrent stenosis had significantly lower vitamin C concentrations (19.10 +/- 3.69 vs 30.11 +/- 19.10, P = .02) than those who did not. This study suggests that low antioxidant vitamin levels may predispose to early restenosis after carotid endarterectomy.

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The influence of smoking and lipids on restenosis after carotid endarterectomy

Cited by 35 publications

References 15 publications

Significance of Carotid Restenosis following Endarterectomy

Significance of Carotid Restenosis following Endarterectomy

Carotid Recurrent Stenosis and Risk of Ipsilateral Stroke

Decreased Antioxidant Vitamin Concentration May Be a Risk Factor for Recurrent Carotid Stenosis

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