Carotid Endarterectomy Reduces Systemic Inflammatory Burden: A Prospective Analysis of Preoperative and Postoperative...

Carotid atherosclerosis is a chronic inflammatory disease in which cytokines, particularly interleukin (IL)-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α), lead to endothelial dysfunction, plaque destabilization, and thromboembolic events. While carotid endarterectomy (CEA) effectively reduces the risk of stroke, its effect on systemic inflammatory biomarkers has not been fully characterized. In this study, we aimed to comprehensively evaluate the changes in inflammatory biomarker profiles after CEA and identify patient subgroups showing different inflammatory responses.

This prospective observational study included 87 consecutive patients who underwent CEA between January 2024 and June 2025 at Hatay Mustafa Kemal University Hospital. Ten inflammatory biomarkers (C-reactive protein [CRP], IL-6, TNF-α, IL-10, IL-1β, tumor necrosis growth factor [TGF]-β, fibrinogen, neutrophil-lymphocyte ratio [NLR], white blood cell count [WBC], and procalcitonin)] were measured from peripheral venous blood samples collected preoperatively (24 h before surgery) and postoperatively (48-72 h after surgery). Serum was obtained after centrifugation for cytokine analysis. Wilcoxon signed-rank tests were used for preoperative and postoperative comparisons; Mann-Whitney U-tests were used for subgroup analyses; and Spearman coefficients were used for correlations.

All 10 biomarkers were significantly reduced in the postoperative period (all P < 0.001). The greatest reductions occurred in IL-6 (-29.3%), NLR (-28.6%), IL-1β (-28.1%), procalcitonin (-27.5%), and CRP (-26.2%), with high effect sizes (Cohen's d > 2.0). Symptomatic patients and those with unstable plaques showed significantly greater reductions in inflammation compared to asymptomatic patients and those with stable plaques (P < 0.05 for CRP, IL-6, fibrinogen, NLR, and IL-1β). IL-6 showed a strong correlation with stenosis severity (ρ = 0.602, P < 0.001). Interestingly, baseline CRP (P = 0.024), IL-6 (P = 0.049), and fibrinogen (P = 0.004) levels were lower in patients who developed restenosis.

CEA delivers significant and consistent reductions in systemic inflammatory biomarkers and shows greater effects in high-risk inflammatory phenotypes. These findings support the anti-inflammatory benefit of carotid revascularization beyond mechanical plaque clearance and suggest potential for inflammatory biomarker-guided patient selection.