Comparison between early and late carotid endarterectomy for symptomatic carotid stenosis in relation to oxidized low-density lipoprotein and plaque vulnerability

• Published in: Journal of vascular surgery Vol. 46; no. 5; pp. 870 - 875
• Main Authors: Suzue, Atsuhiko, MD, Uno, Masaaki, MD, Kitazato, Keiko T., BS, Nishi, Kyoko, MD, Yagi, Kenji, MD, Liu, Hao, MD, Tamura, Tetsuya, MD, Nagahiro, Shinji, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-2007; Elsevier
• Subjects: Aged; Biological and medical sciences; Carotid Stenosis - blood; Carotid Stenosis - pathology; Carotid Stenosis - physiopathology; Carotid Stenosis - surgery; Endarterectomy, Carotid - adverse effects; Female; Humans; Lipoproteins, LDL; Male; Matrix Metalloproteinase 9 - blood; Medical sciences; Middle Aged; Neurology; Oxidative Stress; Stroke - epidemiology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Arterial disease; Vascular disease; Carotid stenosis; Nervous system diseases; Surgery; Central nervous system disease; Cardiovascular disease; Lipoprotein; Endarteriectomy; Cerebrovascular disease; Comparative study; Cerebral disorder
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2007.06.039

Objective Although carotid endarterectomy (CEA), the gold standard in stroke prevention, has been performed in the late stage after the insult, its optimal timing remains unclear. Using biomarkers in plaque and plasma, we evaluated oxidative stress and plaque vulnerability between early and late CEA in symptomatic patients. Methods We compared symptomatic stroke patients who underwent early CEA within 4 weeks of the last insult (group A; n = 15) with those who received CEA in the late stage beyond 4 weeks from the last symptom (group B; n = 57). They were divided into vulnerable (group Av, n = 13; group Bv, n = 33) and stable (group As, n = 2; group Bs, n = 24) subgroups according to the pathologic findings on their plaques. We studied the relationships among their primary symptoms, clinical findings, oxidized low-density lipoprotein levels, and gelatinase A (matrix metalloproteinase [MMP]-9) activity in their plaques and plasma. Results Group A had a variety of symptoms; there was no difference in the outcome of CEA between groups A and B. The plaque and plasma oxidized low-density lipoprotein levels were higher in group A than in group B ( P < .05). The incidence of pathologically vulnerable plaque was higher in group A than in group B. Plaque oxidized low-density lipoprotein levels and MMP-9 activity were similar in group Av and group Bv and were higher in those groups than in group As and Bs. Conclusions We first demonstrated that vulnerable plaques in patients subjected to early CEA manifested a remarkable increase in oxidized low-density lipoprotein and MMP-9 activation. Our findings suggest that early CEA may be beneficial in the aspect of oxidative stress.