The role of hyperhomocysteinemia and elevated serum levels of C reactive protein on carotid restenois

Aim. The aim of this paper was to investigate the influence of preoperative elevated serum levels of homocysteine (HCA) and C-reactive protein (CRP) on the tendency to restenosis after carotid revascularization. Methods. From January 2007 to April 2010 we recorded 223 patients, 165 males (74%) and 58 females (26%) affected by carotid stenosis that underwent to revascularization. The day before operation patients were submitted to a venous blood sample to determine the value of total plasma HCA and CRP. The cut-off point of the HCA and CRP level was found to be 10 μmol/L and 3.5 mg/dl respectively. Results. During a median follow-up of 19 months (range 6-48 months) we recorded 14 cases of carotid restenosis (6.3%). The preoperative mean values of HCA and CRP in the group of patients that presented restenosis after carotid revascularization was 17.32±7.18 for HCA e 4.62±7.08 for CRP. The mean value of HCA was 17.64±5.22 μmol/L in patients with restenosis before reoperation and 17.88±7.16 μmol/L in patients without carotid restenosis (P>0.5; OR .5); in early restenosis (<12 months) patients presented values of HCA 16.64±5.44 vs. 18.7±5.60 in case of late restenosis (>12 months) (P>0.5; OR.5). The mean value of CRP was 4.88±4.57 mg/dL in restenosis before reoperation and 6.31±6.10 mg/dL in patients without restenosis (P=0.55; OR .53). No significant differences were found between serum levels of HCA and CRP in patients with and without carotid restenosis after revascularization. However, multivariate analysis adjusting for age, gender and risk factors revealed atrial fibrillation (P=0.007, OR 5.78) and hypertension (P=0.0005, OR 0.16) as predictive factors of late death during follow-up. Conclusion. The relationship between HHCA and preoperative elevated serum levels of CRP and carotid restenosis was not found to be significant.