title: Nε-(carboxymethyl)lysine in debris from carotid artery stenting: multiple versus nonmultiple postoperative lesions.
abstract: BACKGROUND
  No predictor of postoperative ischemic events has been identified in patients undergoing carotid artery stenting (CAS). We aimed to determine whether N(ε)-(carboxymethyl)lysine (CML) in debris trapped by an embolic protection filter device is a predictor of postoperative ischemic events.
  
  
  METHODS
  We enrolled 27 patients (73.4 ± 7.2 years; 22 male, 5 female) who underwent CAS for carotid artery stenosis. Diffusion-weighted magnetic resonance imaging was performed before and after the procedure. Protein samples were extracted from the debris. CML and myeloperoxidase were examined by solid phase enzyme-linked immunosorbent assay and Western blot analysis.
  
  
  RESULTS
  Seventeen patients had 0 or 1 new lesion (nonmultiple lesions) postoperatively, whereas 10 patients had 2 or more new lesions postoperatively (multiple lesions). The CML concentration of the protein sample was significantly higher in patients with multiple lesions than in those with nonmultiple lesions (6.26 ± 2.77 ng/mg protein and 3.36 ± 1.57 ng/mg protein, respectively; P = .010). Statin therapy for dyslipidemia was associated with a lower incidence of multiple lesions and a lower concentration of CML in the protein sample (P = .004 and P = .02, respectively). Receiver operating characteristic analysis showed that the area under the curve for CML was significantly greater than .5 (.877; 95% confidence interval, .742-1.00).
  
  
  CONCLUSIONS
  CML derived from debris may distinguish between patients with postoperative multiple ischemic lesions and those with postoperative nonmultiple lesions who undergo CAS.
authors.affiliation: Department of Pathology, Faculty of Medicine, Fukuoka University; Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan. Electronic address: Ritsurou@hotmail.com.
authors.forename: Ritsurou
authors.initials: R
authors.lastname: Inoue
authors.affiliation: Department of Pathology, Faculty of Medicine, Fukuoka University.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Sakata
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Nakai
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikawa
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsutsumi
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Nii
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Iko
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Kimiya
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Ayumu
authors.initials: A
authors.lastname: Eto
authors.affiliation: Laboratory of Food and Regulation Biology Department of Bioscience, School of Agriculture, Tokai University Kumamoto, Japan.
authors.forename: Ryoji
authors.initials: R
authors.lastname: Nagai
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital Chikushino, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kazekawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D015153:Blotting, Western; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D057505:Embolic Protection Devices; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008239:Lysine / Q000031:analogs & derivatives* / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000032:analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; C048496:N(6)-carboxymethyllysine; D009195:Peroxidase; D008239:Lysine
keywords: Carotid artery stenting; Nε-(carboxymethyl)lysine; debris; myeloperoxidase; new ischemic lesion