Do standard carotid artery endarterectomy and primary closure technique cause early restenosis in diabetic patients?

Effects of epigallocatechin gallate on total antioxidant capacity, biomarkers of systemic low-grade inflammation and metabolic risk factors in patients with type 2 diabetes mellitus: the role of FTO-rs9939609 polymorphism

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is known as one of the most common metabolic diseases and FTO polymorphism has been implicated in the susceptibility to this disease. Epigallocatechin-3-gallate (EGCG) has shown favorable effects on risk factors related to T2DM. The present study aimed to investigate the effects of EGCG on total antioxidant capacity, biomarkers of systemic low-grade inflammation and metabolic risk factors in patients with T2DM considering the role of FTO polymorphism.

MATERIAL AND METHODS

In this double-blind randomized clinical trial, 60 patients with T2DM (20-60 years) were randomly allocated to three groups. Group 1 received 300 mg of EGCG (TT genotype). Group 2 received 300 mg of EGCG (AA + AT genotypes) and Group 3 received placebo. We genotyped FTO (rs9939609) and measured body mass index (BMI), blood pressure, profile lipid, interleukin-6, high sensitivity C-reactive protein and total antioxidant capacity, before and after the intervention, at 2 months.

RESULTS

In carriers of A allele, EGCG intervention caused a significant decrease in BMI, diastolic blood pressure (DBP), mean arterial pressure and serum cholesterol level compared with placebo (p < 0.05). Also, we found a significant gene-treatment interaction effect between FTO-rs9939609 and EGCG on BMI and DBP (P > 0.05).

CONCLUSIONS

These findings suggest that carriers of the risk alleles (A) of FTO-rs9939609 have a better response to EGCG in improving BMI and DBP in patients with T2DM.

Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy

BACKGROUND

Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates.

METHODS

A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups.

RESULTS

Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684).

CONCLUSION

Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.

Effect of N-acetylcysteine on intimal hyperplasia and endothelial proliferation in rabbit carotid artery anastomosis

INTRODUCTION

Neointimal hyperplasia due to smooth muscle cell migration and proliferation, as well as extracellular matrix accumulation, plays an important role in stenosis and restenosis that develop after reconstructive vascular interventions. Various agents are being tested to reduce neointimal hyperplasia and to prevent lumen stenosis. In the present study, the effect of N-acetylcysteine (NAC) on intimal hyperplasia and endothelial hyperplasia after carotid anastomosis was investigated in a rabbit model.

MATERIAL AND METHODS

In the course of the study, rabbits were divided into two groups. The control group (n = 7) underwent right carotid artery anastomosis and received no medication. The NAC group (n = 7) underwent right carotid artery anastomosis and received NAC for 21 days following surgery. NAC was administered at a dose of 150 mg/kg/day just after the surgery. The carotid artery underwent anastomosis, and the histological examination findings of anastomosed and opposite non-anastomosed carotid arteries were compared in two experimental groups that either received NAC or did not.

RESULTS

Compared with the control group, the reduction in the lumen area and diameter after anastomosis was significantly recovered in the NAC group (p = 0.018; p = 0.612). Increases in the intima and media areas and the intima/media ratio were smaller in the NAC group after anastomosis than in the control group, but the differences were not significant.

CONCLUSIONS

We believe that vascular anastomosis and post-intervention NAC administration will prolong vascular patency by reducing intimal hyperplasia and providing vascular remodeling.

Determination of Ultrastructural Properties of Human Carotid Atherosclerotic Plaques by Scanning Acoustic Microscopy, Micro-Computer Tomography, Scanning Electron Microscopy and Energy Dispersive X-Ray Spectroscopy

Microcalcification is the precursor of vulnerability of plaques in humans. Visualization of such small structures in vivo with high spatial resolution is an unsolved issue. The goal of this study is to evaluate the potential of scanning acoustic microscopy (SAM) in the determination of atherosclerotic plaques with calcifications by validating this technique with micro-computer tomography (micro-CT), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS). The fibrocalcific plaques were obtained from 12 different patients and initially examined with micro-CT. The images exhibited calcifications within these plaques. For imaging with SAM, approximately 5 μm thick slices were prepared. Sound speed values within calcified regions were measured to be greater than the ones in collagen-rich regions. These fibrocalcific plaques were also examined with SEM and EDS revealing collagen and calcium deposition within these samples. The consistency of the results obtained by all of the modalities involved in our study is an indication of the potential of SAM as a clinical tool for the diagnosis of vulnerable plaques.