Restenosis after carotid endarterectomy: significance of newly acquired risk factors.
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.


CONCLUSIONS
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.
Fluri
F
F
Department of Clinical Neurology and Stroke Unit, University Hospital Basel, Petersgraben, Basel, Switzerland. Flurif@uhbs.ch
Hatz
F
F
Voss
B
B
Lyrer
P A
PA
Engelter
S T
ST
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000188:drug therapy; D018450:Disease Progression; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D013997:Time Factors