title: High sensitivity C-reactive protein and vascular endothelial growth factor as indicators of carotid plaque vulnerability.
abstract: BACKGROUND
  Carotid atherosclerotic plaques are one of the causes of cerebral stroke. The risk is higher for the vulnerable plaques but there are no specific markers to identify them. The aim of our study was to identify vulnerable carotid plaques by the mean of atherosclerotic serological markers in patients undergoing carotid revascularization by endarterectomy (CEA) or stenting (CAS).
  
  
  METHODS
  High sensitivity C-reactive protein (hsCRP) and vascular-endothelial-growth-factor (VEGF) levels were assessed preoperatively in patients undergoing carotid revascularization. Carotid plaques vulnerability were investigated in two different methods: the "biological vulnerability" with the histological evaluation of the plaques from CEA, scoring five parameters (microvessel density, fibrous-cap-thickness, calcification, inflammatory infiltrate and lipid core), and the "structural vulnerability" with the evaluation of the plaques debris detached during CAS and captured by the cerebral protection filter, in terms of percentage of filter pores occlusion (OP). Results were correlated using χ2, Fisher's, Mann-Whitney, Student's t-tests and regression analysis.
  
  
  RESULTS
  The histological analysis was performed in 40 specimens, vulnerable plaques (30%) were correlated with higher hsCRP levels (>5mg/l; OR, 2.5; CI 95%, 1.1-5.5; P=0.01) and VEGF levels (VEGF>500 pg/l; OR 3.0, CI 95%, 1.1-7.7; P=0.01). All the filters (N.40) contained microscopic debris (mean OP 26.6%±9.9); higher hsCRP levels (>5mg/l) were correlated with greater than 25% OP (OR, 2.6; CI 95%, 1.2-5.7). An increase in the percentage of OP was also observed in patients with VEGF>500 pg/l (OR, 2.9; CI, 95% 1.3-6.3).
  
  
  CONCLUSIONS
  This study suggests that serological determinants are useful in recognizing the structural and biological vulnerability of carotid plaques.
authors.affiliation: Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Polyclinic, Bologna, Italy - rudypini@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fittipaldi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pini
authors.forename: Gianandrea
authors.initials: G
authors.lastname: Pasquinelli
authors.forename: Raffaella
authors.initials: R
authors.lastname: Mauro
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Beltrandi
authors.forename: Antonio
authors.initials: A
authors.lastname: Freyrie
authors.forename: Mauro
authors.initials: M
authors.lastname: Gargiulo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Faggioli
authors.forename: Andrea
authors.initials: A
authors.lastname: Stella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D016009:Chi-Square Distribution; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012698:Serologic Tests; D015607:Stents; D016896:Treatment Outcome; D015854:Up-Regulation; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*
chemical_list: D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D002097:C-Reactive Protein