Risk Stratification for Adverse Events after Carotid Endarterectomy

Abstract

Patients with symptomatic carotid artery stenosis have a high risk of future ipsilateral cerebrovascular events and this risk can be effectively reduced by a surgival removel of the carotid plaque (carotid endarterectomy, CEA). Despite CEA, these patients maintain at high risk for future major cardiovascular events (MACE) after CEA due to the systemic nature of atherosclerosis. Novel options for intensification of medical treatment (intensive lipid lowering or anticoagulants or new anti-inflammatory drugs) are emerging but have hazardous side effects and are expensive. Therefore, risk stratification tools for MACE are warranted. Clinical parameters fail to accurately discriminate between patients at high risk of MACE and those at low risk. Biomarkers could improve risk prediction models. This thesis investigates several types of biomarkers; circulating blood markers, radiographic markers on cerebral imaging and genetics, in relation to future cardiovascular events in patients undergoing CEA. These biomarkers were also associated to histological characteristics of the carotid plaque in order to increase our understanding of the complex mechanisms of atherosclerosis. In the future, these biomarkers can be useful to select high-risk patients that qualify for intensified medical treatment or follow-up. Ultimately, these biomarkers incorporated in risk prediction models could help physicians select appropriate patients for specific treatments.