Chlamydia pneumoniae, herpes simplex virus and cytomegalovirus in symptomatic and asymptomatic high-grade internal carotid artery stenosis. Does infection influence plaque stability?
BACKGROUND
Current debates are focused on inflammatory processes in atherosclerotic lesions as a possible pathomechanism for destabilization and thrombembolism. In this prospective study the role of systemic and local infection in patients with high-grade internal carotid artery stenosis (ICA) was evaluated.


METHODS
Serum antibody titers of 109 consecutive patients, who underwent surgery for ICA stenosis (asymptomatic n = 40, symptomatic n = 69) were prospectively measured for Chlamydia pneumoniae (Cpn) (IgA and IgG), Herpes simplex virus (HSV) (IgG, IgM) and Cytomegalovirus (CMV) (IgG, IgM) respectively. 53 carotis plaques of this group (asymptomatic n = 17, symptomatic n = 36) could be analyzed by polymerase chain reaction (PCR) for Cpn-, HSV- and CMV-DNA presence.


RESULTS
Seropositivity was found in 61,5% for Cpn, 91,7% for HSV and 72,5% CMV respectively. No significant relation was found between symptomatic and asymptomatic patients as well as no difference was seen for presence of IgA antibodies against Cpn comparing both groups. Plaque-PCR revealed Cpn in 7 cases (13,2%), HSV in 2 cases (3,8%) and no CMV had been detected. Again, no significant relationship was found concerning symptomatic and asymptomatic patients. All 9 PCR-positive plaques displayed lesions of "complicated atherosclerosis" as central fibrous necrosis and calcification or plaque bleeding and surface thrombosis.


CONCLUSIONS
Our results do not support the hypothesis that systemic Cpn, HSV or CMV- infection or evidence of Cpn-, HSV- or CMV-DNA in carotid plaques causes plaque destabilization and cerebral thromboembolism. Plaque infection could only be observed in cases with advanced atherosclerosis.
Müller
B T
BT
Department of Vascular Surgery and Kidney Transplantation, Clinic für Thoracic and Cardiovascular Surgery, Heinrich-Heine-University Düsseldorf, Germany. MuellerB@med.uni-duesseldorf.de
Huber
R
R
Henrich
B
B
Adams
O
O
Berns
G
G
Siebler
M
M
Jander
S
S
Müller
W
W
Loncar
R
R
Godehardt
E
E
Sandmann
W
W
D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D015984:Causality; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D016993:Chlamydophila pneumoniae; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D004198:Disease Susceptibility / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D005858:Germany / Q000453:epidemiology; D006561:Herpes Simplex / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013223:Statistics as Topic