Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Beijing, China.
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
J Vasc Surg. 2021 Jun;73(6):2179-2188.e4. doi: 10.1016/j.jvs.2020.10.084. Epub 2020 Nov 27.
Restenosis after carotid endarterectomy (CEA) limits its long-term efficacy for stroke prevention. Thus, it is of utmost importance to identify the factors that predispose a patient to restenosis after CEA. This systemic review aims to survey the current literature regarding restenosis after CEA and discuss the predictive value of carotid plaque features.
A systemic review of studies on the predictive value of carotid plaque features for restenosis after CEA was conducted according to the PRISMA guidelines. PubMed/MEDLINE and Embase databases were searched up to March 20, 2020. Two authors independently extracted the data and assessed the risk of bias with the Quality in Prognosis Studies tool. Given the heterogeneity in the measurement of prognostic factors, types of CEA, and clinical outcomes, a qualitative synthesis was performed.
Twenty-one articles with a sample size that ranged from 11 to 1203 were included in this systematic review. Based on the presence of calcification in original carotid plaques, two progression patterns of restenosis were hypothesized: patients with calcified plaques may experience a temporary increase in the intima-media thickness (IMT) followed by a decrease in IMT after CEA, whereas patients with noncalcified plaques may experience a gradual increase in IMT after CEA. Accordingly, patients with a high calcium score may have a high restenosis rate within 6 months after CEA and a low restenosis rate thereafter. Thus, the late restenosis rate in patients with uniformly echogenic plaques was lower than that in patients with uniformly echolucent plaques. Pathologically, a lipid-rich, inflammatory carotid plaque is associated with a decreased risk of restenosis within 1 year after CEA, mainly owing to the relatively mild reactive intimal hyperplasia at the surgical site and active inflammation in the remaining media and adventitia. Molecular predictors for restenosis included a Mannose-binding lectin 2 genotype, preoperative C-reactive protein, serum homocysteine, apolipoprotein J, vitamin C, and telomere length of carotid plaques.
This review demonstrated that carotid plaque features, including imaging features, cellular composition, and molecular features, are correlated with the risk of restenosis after CEA. A comprehensive evaluation of plaque characteristics may help to stratify the risk of restenosis after CEA.
颈动脉内膜切除术（CEA）后的再狭窄限制了其预防中风的长期疗效。因此，确定患者在 CEA 后发生再狭窄的易患因素至关重要。本系统综述旨在调查关于 CEA 后再狭窄的现有文献，并讨论颈动脉斑块特征的预测价值。
根据 PRISMA 指南，对关于 CEA 后颈动脉斑块特征对再狭窄预测价值的研究进行了系统性回顾。检索了 PubMed/MEDLINE 和 Embase 数据库，截至 2020 年 3 月 20 日。两位作者独立提取数据，并使用预后研究质量工具评估偏倚风险。由于预后因素、CEA 类型和临床结局的测量存在异质性，因此进行了定性综合分析。
本系统综述纳入了 21 篇文献，样本量从 11 例到 1203 例不等。基于原始颈动脉斑块中钙的存在，假设了再狭窄的两种进展模式：钙化斑块患者在 CEA 后可能会出现暂时的 IMT 增加，随后 IMT 减少，而非钙化斑块患者在 CEA 后可能会出现 IMT 逐渐增加。因此，高钙评分患者在 CEA 后 6 个月内的再狭窄率较高，此后再狭窄率较低。因此，均一回声斑块患者的晚期再狭窄率低于均一低回声斑块患者。从病理学角度来看，富含脂质的炎症性颈动脉斑块与 CEA 后 1 年内再狭窄风险降低相关，主要归因于手术部位相对较轻的反应性内膜增生和剩余中膜和外膜的活跃炎症。再狭窄的分子预测指标包括甘露糖结合凝集素 2 基因型、术前 C 反应蛋白、血清同型半胱氨酸、载脂蛋白 J、维生素 C 和颈动脉斑块的端粒长度。
本综述表明，颈动脉斑块特征，包括影像学特征、细胞组成和分子特征，与 CEA 后再狭窄的风险相关。对斑块特征进行全面评估可能有助于分层 CEA 后再狭窄的风险。
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