Apolipoprotein J as a predictive biomarker for restenosis after carotid endarterectomy: a retrospective study

Anastasios MASKANAKIS1, Nikolaos PATELIS1, Georgios KARAOLANIS1, Spyridon DAVAKIS1, Dimitrios SCHIZAS1, Des-pina PERREA2, Chris KLONARIS1, Sotirios GEORGOPOULOS1, Theodoros LIAKAKOS1, Chris BAKOYIANNIS1
1 First Department of Surgery, Vascular Unit, Laiko General Hospital, National & Kapodistrian University of Athens, Greece
2 Laboratory for Experimental Surgery and Surgical Research “N.S. Christeas”, Medical School, National & Kapodistrian University of Athens, Greece
Correspondence to: Nikolaos PATELIS:,
DOI: 10.1038/aps.2017.146
Received: 22 June 2017
Accepted: 31 October 2017
Advance online: 8 February 2018


Carotid endarterectomy (CEA) is an effective surgical option for stroke prophylaxis in most patients. Restenosis after CEA can lead to re-intervention and adverse events, but the factors predicting restenosis are poorly understood. Apolipoprotein J (ApoJ) is considered to be a novel predictive factor of vascular restenosis and is associated with a large number of processes related to atherosclerosis and cell-cycle phases. The aim of this study was to elucidate the predictive value of Apo J in internal carotid artery (ICA) restenosis following CEA. This retrospective study examined all prospectively collected data for patients who underwent CEA at our surgical department over a 2-year period. The serum ApoJ levels of 100 patients were examined; 56 patients who underwent CEA comprised the vascular group (VG), and 44 patients who underwent minor surgery comprised the control group (CG). ApoJ samples were obtained preoperatively, 24 h after the surgical procedure and at 1, 6 and 12 months thereafter during the follow-up. The preoperative difference in ApoJ levels between the CG and VG was statistically signifcant; the mean values were 39.11±14.16 and 83.03±35.35 μg/mL, respectively. In the VG, the serum ApoJ levels were 112.09±54.40, 71.20±23.70, 69.92±25.76 and 62.25±19.17 μg/mL at postoperative day 1 and at 1, 6 and 12 months post-operatively, respectively, while the ApoJ concentrations of patients in the CG remained unchanged. Further subdivision of the VG into patients with or without restenosis revealed that restenosis patients presented signifcantly higher mean ApoJ values than non-restenosis VG patients. In summary, ApoJ seems to be an important predictor for carotid restenosis at 6 and 12 months postoperatively.
Keywords: atherosclerosis; carotid endarterectomy; vascular restenosis; biomarker; apolipoprotein J; clusterin

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