on October 4, 2007
Published online before print October 4, 2007, doi: 10.1161/ATVBAHA.107.146860
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Submitted on April 24, 2007
Accepted on September 20, 2007
Low C1-Inhibitor Levels Predict Early Restenosis After Eversion Carotid Endarterectomy
Gábor Széplaki ;
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.
* To whom correspondence should be addressed. 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.
Key words: carotid arteries • genetics • inflammation • restenosis • risk factors