https://orcid.org/0000-0002-0070-9197
Arteriosclerosis obliterans (ASO), which mainly affects medium- and large-sized arteries of the lower extremities, is characterized by thickening and calcification of arterial walls due to atherosclerotic plaque formation, resulting in decreased blood supply to the effected extremity [Citation1]. It has been shown that ASO is commonly seen in patients aged 55-75 years [Citation2]. Multiple risk factors, including older ager, male gender, heavy smoking, diabetes, hypertension, and chronic renal failure, have been demonstrated to be associated with ASO [Citation3]. The clinical manifestations in patients with ASO may range from intermittent claudication to the acute occlusion of the effected artery. Nowadays, percutaneous vascular interventions, including balloon angioplasty and stent implantation, have become the main treatment option to treat such patients [Citation3]. However, studies have shown that approximately 30-50% of patients develop restenosis within 1 year after the index procedure, which raises concerns about the long-term safety and efficacy of such procedures [Citation2,Citation3]. Since an evidence-based treatment for restenosis has not been yet clarified, predicting restenosis by identifying its potential causes has still the utmost importance.
Endothelin-1 (ET-1), which is secreted by vascular endothelial cells, plays a key role in controlling vascular tone in human body [Citation4]. Besides its role as a vasoconstrictor, ET-1 may act as proinflammatur substance. A number of recent studies have confirmed the prognostic role of ET-1 in patients with stable coronary artery disease and acute coronary syndrome [Citation5,Citation6].
C-reactive protein (CRP) is a well-known and the most studied marker of systemic inflammation in patients with cardiovascular diseases [Citation7,Citation8]. Notably, in a recent published study, it has been shown that the inflammation has a critical role in the pathogenesis of restenosis in patients with peripheral arterial disease who undergo endovascular therapy [Citation9].
In this issue of Journal of Investigative Surgery [Citation10], the researchers have performed a prospective clinical study to test the potential role of ET-1 and CRP in restenosis after the intervention of lower extremity ASO. The serum levels of ET-1 and CRP were measured before and after procedure, at 1 month and 3 months after index procedure. In addition to the positive correlation between serum levels of ET-1 and CRP at 1 and 3 month after surgery, both serum biomarkers were found to be independent risk factors in ASO patients who developed restenosis. As the authors stated, the present study may provide potential biomarkers for restenosis after intervention for lower extremity ASO. In addition, we believe that since statins can significantly decrease systemic inflammation, ASO patients who are candidate for percutaneous vascular intervention and have higher pre- and post-procedural levels of ET-1 and CRP may need a more aggressive statin treatment during follow-up period to decrease the risk of development of restenosis. Therefore, this research highlights the need to conduct a randomized and prospective study which evaluates this treatment regimen in near future.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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