title: Blood-borne tissue factor activity predicts major cerebrovascular events in patients undergoing carotid endarterectomy: results from a 1-year follow-up study.
abstract: BACKGROUND
  Tissue factor (TF) expression is increased in inflammatory atherosclerotic plaques and has been related to plaque thrombogenicity. Blood-borne TF activity seems to contribute to a procoagulant state in patients with vascular risk factors. The aim of this study was to assess whether the expression of TF in carotid plaques from patients undergoing carotid endarterectomy (CEA) or/and blood-borne ('circulating') TF activity could predict future vascular complications.
  
  
  METHODS
  A total of 105 consecutive patients (85 male and 20 female aged 61-77 years)undergoing CEA for high-grade internal carotid artery were included in the study. Carotid artery specimens were classified into active (n = 52; rich in inflammatory cells) and nonactive plaques (n = 53; poor in inflammatory cells or fibrous). TF mRNA levels in carotid plaques were assessed by real-time PCR (TaqMan Low-Density Arrays) and TF protein levels by Western blot. Blood-borne TF activity and other biochemical parameters, including low-density lipoprotein cholesterol (LDLc) levels and high-sensitivity C-reactive protein, were measured prior to surgery. Patients were followed up for 1 year and vascular and nonvascular complications were scored.
  
  
  RESULTS
  TF expression was higher in active CEA plaques. Patients with active CEA plaques exhibited higher plasma LDLc levels (3.6 +/- 0.7 vs. 2.1 +/- 1 mM, p < 0.05) that positively correlated with plaque TF mRNA levels (p = 0.0125; r = 0.9). Blood-borne TF activity did not correlate with plasma LDLc levels and was unrelated to the anatomo-pathological characteristic of the CEA plaques (thrombosis, rupture, inflammation, lipid core, necrosis or calcification). Circulating TF activity predicted vascular complications at 1 year, including fatal (OR, 1.18; 95% CI, 0.6-2.2, p < 0.01) and nonfatal ischemic stroke (OR, 1.22; 95% CI, 0.5-2.0, p < 0.05) and symptomatic peripheral vascular disease (OR, 1.48; 95% CI, 0.4-2.6, p < 0.005).
  
  
  CONCLUSIONS
  Blood-borne TF activity prior to CEA but not local TF expression or plasma LDLc levels predict cerebrovascular and peripheral vascular disease events at 1 year in elderly patients subjected to CEA for high-grade carotid stenosis.
authors.affiliation: Department of Neurology, University Hospital of Bellvitge, Fundació IDIBELL, Barcelona, Spain. krupinski@csub.scs.es
authors.forename: Jerzy
authors.initials: J
authors.lastname: Krupinski
authors.forename: Marta M
authors.initials: MM
authors.lastname: Turu
authors.forename: M Angels
authors.initials: MA
authors.lastname: Font
authors.forename: Esther
authors.initials: E
authors.lastname: Catena
authors.forename: Mark
authors.initials: M
authors.lastname: Slevin
authors.forename: Sergio
authors.initials: S
authors.lastname: Morchon
authors.forename: Francisco
authors.initials: F
authors.lastname: Rubio
authors.forename: Lina
authors.initials: L
authors.lastname: Badimon
authors.forename: José
authors.initials: J
authors.lastname: Martínez-González
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000097:blood* / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology*; D008078:Cholesterol, LDL / Q000097:blood; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012333:RNA, Messenger / Q000378:metabolism; D013925:Thromboplastin / Q000235:genetics / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D012333:RNA, Messenger; D013925:Thromboplastin