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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:2756.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Low C1-Inhibitor Levels Predict Early Restenosis After Eversion Carotid Endarterectomy

Gábor Széplaki; Lilian Varga; Judit Laki; Edit Dósa; Szabolcs Rugonfalvi-Kiss; Hans O. Madsen; Zoltán Prohászka; Andrea Kocsis; Péter Gál; Attila Szabó; György Acsády; István Karádi; László Selmeci; Peter Garred; George Füst; László Entz

From the 3rd Department of Internal Medicine (G.S., L.V., J.L., S.R.-K., Z.P., I.K., G.F.) and the Department of Cardiovascular Surgery (E.D., A.S., G.A., L.S., L.E.), Semmelweis University, Budapest, Hungary; Tissue-Typing Laboratory-7631 (H.O.M., P. Garred), Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark; the Research Group of Inflammation Biology and Immunogenomics (Z.P., I.K., G.F.), Hungarian Academy of Sciences, Budapest, Hungary; and the Institute of Enzymology (A.K., P. Gal), Biological Research Center, Hungarian Academy of Sciences, Budapest, Hungary.

Correspondence to Prof George Füst, MD, DSc, 3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Kútvölgyi út 4, H-1125, Hungary. E-mail fustge{at}kut.sote.hu

Objective— Homozygotes for the normal (A) allele of mannose-binding lectin (MBL2) gene have higher risks to develop an early restenosis after eversion carotid endarterectomy (CEA). Activation of the lectin pathway is regulated by C1-inhibitor (C1-INH). The objective of the present study was to determine the predictive value of C1-INH in restenosis after CEA.

Methods and Results— C1-INH and MBL-associated serine protease-2 (MASP-2) were determined in samples serially taken from 64 patients with CEA, who were followed-up with carotid duplex scan (CDS) examinations for 14 months. MBL2 genotypes were also determined. Patients with >50% restenosis had lower C1-INH levels at 6 weeks (P=0.0052) and at 4 days (P=0.0277) postsurgery. C1-INH levels at 6 weeks correlated inversely with the CDS values at 14 months (r=–0.3415, P=0.0058), but only in MBL2 A/A homozygotes (r=–0.5044, P=0.0015). Patients with low C1-INH levels (C1-INH <115%) had higher CDS values already at 7 months postsurgery. Patients with MBL2 A/A and low C1-INH levels at 6 weeks postsurgery had 13.97 (95% CI:1.95 to 100.21, P=0.0087) times higher risk to develop an early restenosis. Differences in the MASP-2 concentration were not associated with restenosis.

Conclusions— Determining C1-INH levels at 6 weeks postsurgery—together with genotyping of MBL2—might be a useful marker in the identification of patients with high risk for early carotid restenosis.

Concentrations of C1-inhibitor were determined in samples serially taken from patients who were followed-up after carotid endarterectomy. Low C1-INH levels at 6-weeks postsurgery predicted the development of an early restenosis, indicating that it might be a marker in the identification of patients with high risk for early restenosis.

Key Words: carotid arteries • genetics • inflammation • restenosis • risk factors