Atherosclerotic Plaque Composition and Occurrence of Restenosis After Carotid Endarterectomy

Abstract

ESTENOSIS IS A DRAWBACK OF catheter-based and surgical interventions in different vascular territories. In coronary and peripheral artery disease, diabetes has been associated with increased development of restenosis. 1-4 In addition, following carotid artery interventions, smoking, age, and female sex have been reported as independent predictors of luminal renarrowing. 5-8 Furthermore, angiographic lesion characteristics, such as lesion length and decreased vessel diameter, are associated with increased risk of restenosis. 9,10 In contrast with established risk factors and angiographic parameters, the relationship between local composition of the vessel wall and development of restenosis has not been explored. Among many other factors, restenosis largely depends on local smooth muscle cell proliferation and migration, protease activity, and matrix deposition occurring at the lesion site after the intervention has been per

Clinical Risk Factors and Plaque Characteristics Associated with New Development of Contralateral Stenosis in Patients Undergoing Carotid Endarterectomy

“…Previous studies have reported a correlation between small lipid core and development of ipsilateral restenosis after CEA [9,10]. The results of our study could therefore underline that atherosclerosis is a generated disease of the vascular system [20,21], by showing risk factors for development of stenosis of the carotid artery that are similar to risk factors for ipsilateral stenosis, as found in previous studies.…”

“…Especially, SMCs are components of a stable plaque phenotype, characterized by less inflammation and lower lipid content [22]. Earlier studies reported that removal of a stable atherosclerotic plaque gives more restenosis 1 year after follow-up [9,14]. In our study, removal of a stable plaque gives more contralateral stenosis, which suggests again that vascular disease is more extensive than only in the operated artery.…”

“…The atherosclerotic plaque was immediately brought to the laboratory after removal during CEA. Plaque characteristics were scored by 2 independent observers blinded for clinical outcome with a good intra-observer and inter-observer reproducibility [9]. Scoring was analyzed in 2 categories (no/minor or moderate/heavy staining) for macrophages, smooth muscle cells (SMCs), calcification, collagen and lipid core.…”

“…Next to clinical and demographic factors, it could be useful to establish which plaque characteristics are predictive for contralateral stenosis development. Potentially, information derived from the removed carotid atherosclerotic plaque individualizes treatment decisions by using non-invasive plaque imaging [9]. …”

Effect of Birth Size and Catch-Up Growth on Adult Blood Pressure and Carotid Intima-Media Thickness

“…This indicates that women have a relatively thicker carotid arterial wall. One explanation might be a different composition of the arterial wall in women which might preclude a different plaque phenotype in later life than men [36]. Our data warrant further investigation.…”