Effect of the Pre-Operative Systemic Inflammatory Response on Outcomes Following Carotid Endarterectomy for Symptomatic Carotid Stenosis

Abstract

Objective: Stroke accounts for over 100 000 acute hospital presentations per year in the UK, and approximately 4 500 carotid endarterectomies are performed annually in the UK.1 This is despite a relative paucity of cases performed for asymptomatic carotid stenosis, in comparison with other countries.1 Periprocedural stroke and death rates have fallen in recent years,2 although these remain notable risks necessitating careful patient selection and counselling. Chronic activation of the systemic inflammatory response (SIR) is prevalent in patients with atherosclerotic disease and influences both the pathogenesis and prognosis.3,4 The neutrophil:lymphocyte and platelet:lymphocyte ratios (NLR, PLR) are markers of the SIR, and are reported to provide prognostic value in patients with acute stroke,5 and in patients undergoing carotid endarterectomy.6 The Modified Glasgow Prognostic Score (mGPS) is calculated from C-reactive protein (CRP) and albumin and was originally described in patients with cancer.7 More recently mGPS has been shown to provide prognostic value in non-cancer patient groups.8 mGPS is representative of an alternative pathway activating the SIR and is not reported in relation to carotid endarterectomy outcomes. The present study describes experience of the prognostic value of these pre-operative markers of SIR in patients undergoing carotid endarterectomy.