Urinary cysteinyl leukotrienes in one-year follow-up of percutaneous transluminal angioplasty for peripheral arterial occlusive disease.
Treatment of severe peripheral arterial occlusive disease requires percutaneous revascularization. However, little is known about risk factors or predictors for reocclusion/restenosis. Cysteinyl leukotrienes are highly bioactive lipid mediators of inflammation. Their intravascular production may take place in the atheromatous plaque or result from interaction within activated leukocyte-platelet aggregates.



We prospectively measured urinary leukotriene E4, the main end-metabolite of cysteinyl leukotrienes in a group of 179 subjects with peripheral artery occlusive disease of the lower extremities. At the enrollment to the study, 22.9% had angioplasty and the remaining had angioplasty with stent implantation. During 12-month follow-up, 29.6% developed reocclusion/restenosis despite a standard pharmacotherapy. We evaluated treatment outcomes at 1, 3, 6 and 12-month follow-up visits, along with urinary leukotriene E4 excretion.



During the study period, we observed a linear increase of urinary leukotriene E4 excretion only in subjects whose lower limb ischemia worsened. Moreover, elevated leukotriene E4 in urine was found only in subjects who developed reocclusion/restenosis. This was significant not only as a coincidence at the time of the follow-up visit, but leukotriene E4 elevation preceded clinical manifestation of reocclusion/restenosis.



Our results demonstrated that serial measurements of urinary leukotriene E4 allowed to predict failure of angioplasty with/or without stent implantation for peripheral artery occlusive disease. However, to prove causality between cysteinyl leukotrienes overproduction and occlusive lower limb ischemia, a clinical trial with leukotrienes modifying drugs would be required.
Department of Angiology, 2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
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P
Maga
Division of Molecular Biology and Clinical Genetics, 2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
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M
Sanak
Department of Angiology, 2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
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B
Rewerska
Jagiellonian University Medical College, Krakow, Poland. Electronic address: mikolaj.maga@gmail.com.
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M
Maga
Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland.
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Jawien
Jagiellonian University Medical College, Krakow, Poland.
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A
Wachsmann
Department of Family Medicine, Kansas University School of Medicine, Wichita, USA.
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P
Rewerski
2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
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W
Szczeklik
2nd Chair of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland.
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Celejewska-Wójcik
D000368:Aged; D017130:Angioplasty; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D015415:Biomarkers / Q000378:metabolism; D023903:Coronary Restenosis; D003545:Cysteine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia; D017999:Leukotriene E4 / Q000378:metabolism / Q000652:urine; D015289:Leukotrienes / Q000652:urine*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors
D015415:Biomarkers; D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D017999:Leukotriene E4; D003545:Cysteine
Atherosclerosis; Biomarkers; Leukotrienes; Percutaneus transluminal angioplasty; Peripheral arterial disease; Restenosis