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

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.

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

“…According to the results reported by Niculescu et al, a high preoperative value of NLR was a strong predictor of 12-month restenosis and mortality following carotid endarterectomy. In this study, the optimal NLR cut-off value for restenosis was 3.47, a finding that aligned with our results [ 28 ]. Another study examined the predictive value of inflammatory markers on outcomes of patients with end-stage kidney disease, demonstrating that high NLR values were associated with 30-day mortality, number of days in hospital, and number of dialysis sessions per patient [ 27 ].…”

“…Even though univariate analysis in our study proved NLR to be a significant predictor of short-term survival, the multivariate regression analysis suggested that NLR is not an independent prognostic factor, thus asserting the clinical significance of combining preprocedural values of NLR and PNI in our proposed 60-day survival score for discerning patients with expected poor outcomes. High NLR values have been associated with unfavorable outcomes in patients with carotid artery and end-stage kidney disease [ 27 , 28 ]. According to the results reported by Niculescu et al, a high preoperative value of NLR was a strong predictor of 12-month restenosis and mortality following carotid endarterectomy.…”

“…Multiple studies published in the literature have shown the prognostic value of NLR in colorectal cancer, gastric cancer, lung cancer, and pancreatic cancer [ 21 , 22 , 23 , 24 , 25 ]. In addition to malignant diseases, PNI and NLR are extensively investigated in chronic conditions such as vascular and kidney diseases, where systemic inflammation plays a role in the progression of the disease and unfavorable outcome [ 26 , 27 , 28 , 29 ]. PNI reflects the patient’s immunonutritional status, while NLR reflects the patient’s inflammation status, both of which are easily available, highly reproducible, and inexpensive tests obtained via routine blood analysis [ 30 ].…”

Proximal Femur Fractures in the Elderly—A Novel Modality to Predict Mortality: The Neutrophil-to-Lymphocyte Ratio

“…Over the past decade, NLR has been extensively studied as a rapid, widely available, and inexpensive biomarker of the systemic inflammatory response. Elevated NLR levels were found to be a significant predictor of adverse outcomes and mortality in patients with a wide range of orthopedic conditions [ 17 , 18 ] as well as non-orthopedic conditions such as cardiovascular [ 19 , 20 , 21 , 22 , 23 , 24 ], renal [ 25 , 26 ], COPD [ 27 ], inflammatory [ 28 , 29 ], oncologic [ 30 , 31 , 32 , 33 ], and various postoperative conditions [ 34 ]. Thus, it is reasonable to assume that NLR is a marker of frailty or poor health and that it could be used for better risk stratification in the fields of orthopedic surgery as well as internal medicine.…”

National Trends in Statin Use in Lithuania from 2010 to 2021

“…Statin therapy for primary prevention has also been proven beneficial [ 3 , 4 , 5 , 6 , 7 ]. In addition, recent studies indicate that statin use is also associated with a reduced risk of carotid restenosis after endarterectomy, cardiovascular (CVD) and even non-CVD mortality [ 8 , 9 ]. However, the benefit seems to be more pronounced in patients in higher-risk groups and/or with higher baseline LDL-C levels; thus, the debate about whether patients with lower baseline LDL-C and/or patients in low- or medium-risk groups should be treated is ongoing [ 3 , 4 , 5 , 6 , 7 ].…”