IMPAIRMENT OF ENDOTHELIUM-DEPENDENT VASODILATATION AND HYPERHOMOCYSTEINEMIA: PROGNOSTIC IMPLICATIONS OF ENDOTHELIAL DYSFUNCTION AFTER CAROTID ENDARTERECTOMY

Umarov B.Y., Abdurakhmanov M.M. and Abdurakhmanov Z.M.*

ABSTRACT

Objective: To evaluate and compare pre- and post-patch (p-CEA) and eversion carotid endarterectomy (e-CEA) markers of endothelial dysfunction in order to improve the diagnosis, surgical results of patients with carotid artery disease. Materials and methods: From October 2014 to October 2019, we examined 87 patients who underwent p-CEA (n=38) and p-CEA (n=49) at our medical center. Preoperative flow-mediated dilation (FMD) of brachial artery and pre- and immediate postoperative homocysteine level were compared between groups. Results: In the preoperative period, the impairment of endothelium-dependent vasodilatation and level of homocysteine of a higher than >10 mmol/l appeared to be experienced in 77 (88,5%) and 82 (94,2%) patients, respectively. In patients of the p-CEA group, the average FMD of the brachial artery was 5,67±1,54%, and 5,51±1,64% which was significantly lower than those of the e-CEA of 6,85±1,70% and 6,13±1,75% at 30 and 60 seconds post-cuff release, respectively (p<0,05). On day 6 after the operation, the homocysteine concentration increased compared to the preoperative level from 15,80±4,32 to 18,4±4,2 μmol/l (p<0,05) in the p-CEA group. In contrast, a preoperative homocysteine level of 13,10±3,15 μmol/l reached up to 14,2±5,6 μmol/l in the e-CEA group without significant difference (p>0,05). Conclusion: In the preoperative period, the flow-mediated dilation test showed better result in favor of e-CEA when compared to p-CEA. In the postoperative period, the growth of the homocysteine level was observed in the p-CEA group in contrast to e-CEA. Further study will be required to detect the precise association of hyperhomocysteinemia with suboptimal hemodynamic parameters of p-CEA.

Keywords: endothelial dysfunction, carotid endarterectomy, flow-mediated dilation, hyperhomocysteinemia.