Background: Intimal hyperplasia is a common complication occurring after carotid endarterectomy (CEA), although pathological mechanisms leading to its progression are not totally clear.

Methods: In our study we assessed a role of various factors including age, gender, hypertension, history of smoking, hyperlipidaemia, diabetes mellitus, lesions characteristics, type of arteriotomy closure and regional flow dynamics affecting intima-media thickness (IMT) past CEA. We examined 1003 patients prior to and 1 year after carotid endarterectomy using standardized duplex ultrasound examination. The median age of patients was 60±15 years. Univariate and multivariate regression analysis was used to identify major risk factors and possible correlations between them.

Results: Only 2 of systemic factors - elevated level of low-density lipoprotein and platelet aggregation were found to have a minor (although statistically significant) effect on IMT after CEA. Age, gender, hypertension, smoking were not significantly associated with the development of intimal hyperplasia past CEA. Complicated plaques showed a significant correlation with intimal hyperplasia. There were no significant differences in IMT between patients who have had eversion CEA versus CEA with patch.^. Of local factors, only sheer stress demonstrated a negative correlation with IMT.

Conclusions: Our results demonstrate that multiple risk factors could be involved in the development of intimal thickening after CEA.