Website is intended for physicians



Aim: was to analyze long-term results of carotid endarterectomy (CEA) in patients with unilateral lesion of the internal carotid artery (ICA), the lack of/or insignificant lesion on the contralateral side on statin therapy.

Materials and methods: for the period January 2009-December 2010, 262 CEA performed in 262 patients. Evaluated results of survival rate, stroke and myocardial infarction, condition of carotid arteries, effect of various factors on features of atherosclerotic lesions and effect of statin therapy on these processes.

Results: in late follow-up period - 245(93,5%) survivors. Patients were divided into groups: simvastatin - 60(24,5%) patients, atorvastatin - 134(54,7%) observations, rosuvastatin - 51(20,8%) cases. 14 patients died, data were obtained on the 13, average loss of 6.06%. The frequency of cardiovascular events leading to death is seven cases. Non-fatal stroke of any location - 5(1,9%) observations. The influence of hypertension (p=0,019), smoking (p=0,004), type 2 diabetes (p=0,03), dyslipidemia: hypercholesterolemia (p=0,05), hypertriglyceridemia (p=0,02), low-density lipoprotein (LDL) level is higher than normal (p=0,015), high-density lipoprotein (HDL) is below normal (p = 0,03) and other factors. Lowering cholesterol by 5,9% is marked in the atorvastatin group, maintaining at recommended values throughout the period from the initial selection in the rosuvastatin group (p = 0,0001). LDL cholesterol decreased by 19,1% in the mean value in the atorvastatin group (p = 0,0001), the increase of HDL level of 3,4% in the rosuvastatin group (p=0,02). Achievement of recommended levels of cholesterol was more often observed in the rosuvastatin group at 64,7% compared with simvastatin (p = 0,03). Risk factors influenced the incidence of restenosis ipsilateral side in 3 patients (1,2%). The greatest influence of risk factors was determined in the atorvastatin group (4,1%, p=0,001). Atorvastatin therapy stabilized the wall of the ICA 17,6% more often (p=0,05) and contralateral common carotid artery, leaving it intact at 84,6% (p=0,002) compared with other groups of statins.

Conclusion: the purpose of statin therapy depends on the severity of the atherosclerotic process the characteristics of the lipid profile and the need correction of risk factors. The most effect is provided by the group of synthetic statin above semisynthetic. Atorvastatin therapy is effective with moderate hypercholesterolemia; rosuvastatin prescribed with severe dyslipidemia.



1.      Rothwell P.M., Eliasziw M., Gutnikov S.A., Fox A.J., Taylor D.W., Mayberg M.R. et al. Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003; 361: 107-116.

2.      AbuRahma A.F., Srivastava M., Stone P.A. Effects of Statins on Early and Late Clinical Outcomes of Carotid Endarterectomy and the Rate of Post-Carotid Endarterectomy Restenosis. J Am Coll Surg. 2015;220:481-488.

3.      Sillesen H., Amarenco P., Hennerici M.G., Callahan A., Goldstein L.B., Zivin J. et al. Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Stroke. 2008; 39: 3297-3302.

4.      O'Regan C., Wu P., Arora P., Perri D., and Mills E.J. Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am J Med. 2008; 21: 24-33.

5.      Perler B.A. The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007; 20: 252-258.

6.      McGirt M.J., Perler B.A., Brooke B.S., Woodworth G.F., Coon A., Jain S. et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J. Vasc Surg. 2005; 42: 829-836.

7.      Paraskevas K.I., Athyros V.G., Briana D.D., Kakafika A.I., Karagiannis A., and Mikhailidis, D.P. Statins exert multiple beneficial effects on patients undergoing percutaneous revascularization procedures. Curr Drug Targets. 2007; 8: 942-951.

8.      Koh K.K. Effects of statins on vascular wall (vasomotor function, inflammation, and plaque stability). Cardiovasc Res. 2000; 47: 648-657.

9.      Amarenco P., Labreuche J., Lavallee P., and Touboul, P.J. Statins in stroke prevention and carotid atherosclerosis (systematic review and up-to-date meta-analysis). Stroke. 2004; 35: 2902-2909.

10.    Amarenco P. and Labreuche J. Lipid management in the prevention of stroke: review and updated metaanalysis of statins for stroke prevention. Lancet Neurol. 2009; 8: 453-463.

11.    Pokrovsky A.V., Beloyartsev D. F., Talibli O. L. Analysis of long-term results of eversion carotid endarterectomy. Angiology and vascular surgery. 2014; 20 (4): 100-108 [In Russ].

12.    Efthymios D. Avgerinos Rabih A., Abdallah Naddaf, Omar M. El-Shazly, Luke Marone, Michel S. Makaroun. Primary closure after carotid endarterectomy is not inferior to other closure techniques. Presented at the Vascular and Endovascular Surgery Society 2015 Summer Meeting, Chicago, Ill, June 17-20, 2015.

13.    Taylor A.J., Kent S.M., Flaherty P.J., Coyle L.C., Markwood T.T., and Vernalis, M.N. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002; 106: 2055-2060.

14.    Taylor A.J., Sullenberger L.E., and Lee H.Y ARBITER 3: Atherosclerosis regression during open-label continuation of extended-release niacin following ARBITER 2. Circulation. 2005; 112: II-179.

15.    Jones P., Davidson M., Stein E. et al. STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR  Trial). Am. J. Cardiol. 2003; 92(2): 152-160.

16.    Crouse J.R. III, Raichlen J.S., Riley W.A. et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007;297:1344-1353.

17.    Radak D., Tanaskovic S., Matic P., et al. Eversion Carotid Endarterectomy - Our Experience After 20 Years of Carotid Surgery and 9897 Carotid Endarterectomy Procedures. Ann. Vasc. Surg. 2012; 26(7): 924-928.

18.    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995; 273: 1421-1428.

19.    Sever P.S., Poulter N.R., Dahlof B. et al. Different Time Course for Prevention of Coronary and Stroke Events by Atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Am J Cardiol. 2005; 96: 39-44.

20.    Paraskevas K.I., Hamilton G., Mikhailidis D.P. Statins: an essential component in the management of carotid artery disease. J Vasc Surg. 2007; 46: 373-386. (АНГИОЛОГИЯ.ру) - портал о диагностике и лечении заболеваний сосудистой системы