Increased systemic oxidative stress after elective endarterectomy - Relation to vascular healing and remodeling

It has been reported that systemic and local redox state may have an import ant role in the functional and organic changes characterizing the process o f vascular response to injury. Carotid endarterectomy to remove atheroscler otic plaque is followed by a long lasting healing and remodeling process th at can be carefully followed over time with noninvasive ultrasonography. Pl asma vitamin C concentration and native LDL (n-LDL) content in lipid peroxi des, vitamin E, beta-carotene, and lycopene as well as LDL susceptibility t o peroxidation were assessed in 45 patients undergoing elective endarterect omy for internal carotid stenosis, at baseline, 24 hours, 3 and 15 days, an d 1 month after surgery. Serial duplex scans were performed in all patients postoperatively and 3, 6, and 12 months. The changes in far wall thickness (FW) and % renarrowing from postoperatively to 12 months were used as remo deling indices. Plasma antioxidant vitamins and lag-phase showed a sharp an d significant decrease during the first 24-hours after surgery remaining un changed until the third day, whereas, an opposite trend was evidenced for n -LDL content in lipid peroxides and serum ceruloplasmin, After the third da y all the parameters returned progressively to baseline within one month fr om endarterectomy. Interestingly, the n-LDL lipid peroxide content, the ser um ceruloplasmin and the plasma vitamin C concentration, measured at 24 and 3 days from surgery, were significantly associated to the change in % rena rrowing from postoperatively to 12 months. The higher the LDL content in li pid peroxides, the higher the serum level of ceruloplasmin, the lower the p lasma content in vitamin C and the higher the % of vessel renarrowing. In c onclusion, carotid endarterectomy with atherosclerotic plaque removal is as sociated with an acute and prolonged increase in systemic oxidative stress that influences vascular healing and late luminal loss.