title: Analysis of the acute systemic and tissue inflammatory response following carotid endarterectomy.
abstract: BACKGROUND
  We aimed to investigate the acute systemic and tissue inflammatory response associated with carotid endarterectomy (CEA) and analyze the association between serum and tissue biomarkers and histological features of carotid plaques between symptomatic and asymptomatic patients.
  
  
  METHODS
  We studied 11 patients (6 symptomatic and 5 asymptomatic) with ≥70% internal carotid stenosis treated with CEA. Serum expression of interleukin (IL) 1β, IL-4, IL-6, IL-8, IL-10, metalloproteinase (MMP) 8, MMP-9, tumor necrosis factor-α (TNF-α), high-sensitive C-reactive protein (hs-CRP), and vascular endothelial growth factor (VEGF) were measured in the preoperative period and 1, 6 and 24 hours after CEA. Assessment of tissue biomarkers (IL-1β, IL-4, IL-6, IL-8, IL-10, MMP-8, MMP-9, TNF-α, and VEGF) and histological analyses were performed on carotid plaques.
  
  
  RESULTS
  Peak serum values for MMP-8, MMP-9, IL-6, and IL 10 were observed 6 hours after CEA, whereas for hs-CRP, TNF-α, and VEGF, they were identified 24 hours after the procedure. Symptomatic patients exhibited higher serum concentrations of MMP-8, MMP-9, IL-1β, IL-4, IL-8, hs-CRP and TNF-α and higher tissue concentrations of MMP-8, MMP-9, IL-1β, IL-6 and VEGF than asymptomatic patients. Significant difference was found between symptomatic and asymptomatic patients in tissue IL-6 levels (30.95 pg/mL and 9.33 pg/mL, respectively; P=0.028).
  
  
  CONCLUSIONS
  Systemic and tissue inflammatory response occurs even after CEA, being observed important activity of inflammatory and anti-inflammatory cytokines at 6 and 24 hours after CEA. Symptomatic patients show higher concentrations of serum and tissue biomarkers in comparison to asymptomatic patients.
authors.affiliation: Department of Vascular Surgery, School of Medical Sciences, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil - sthefanogabriel@yahoo.com.br.
authors.forename: Sthefano A
authors.initials: SA
authors.lastname: Gabrile
authors.forename: Leila
authors.initials: L
authors.lastname: Antonangelo
authors.forename: Vera R
authors.initials: VR
authors.lastname: Capelozzi
authors.forename: Camila B
authors.initials: CB
authors.lastname: Beteli
authors.forename: Otacílio
authors.initials: O
authors.lastname: DE Camargo
authors.forename: José L
authors.initials: JL
authors.lastname: Braga DE Aquino
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Caffaro
mesh_terms: D000368:Aged; D001938:Brazil; D002097:C-Reactive Protein / Q000032:analysis; D016893:Carotid Stenosis / Q000601:surgery*; D016207:Cytokines / Q000378:metabolism*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D020784:Matrix Metalloproteinase 8 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D008875:Middle Aged; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D016207:Cytokines; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D002097:C-Reactive Protein; C488762:MMP8 protein, human; D020784:Matrix Metalloproteinase 8; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9