Switching off embolization from symptomatic carotid plaque using S-nitrosoglutathione

Area of Science:

• Neurology
• Vascular Medicine
• Pharmacology

Background:

• Recurrent strokes remain a significant risk despite current antiplatelet therapies.
• Asymptomatic circulating emboli detected by transcranial Doppler ultrasound predict stroke risk in patients with carotid stenosis.
• S-nitrosoglutathione (GSNO), a nitric oxide donor with platelet specificity, was investigated for its anti-embolic potential.

Purpose of the Study:

• To evaluate the effectiveness of GSNO in reducing embolization in patients with symptomatic carotid stenosis.
• To assess the impact of GSNO on embolic signals in patients already treated with aspirin.

Main Methods:

• A double-blind, randomized study involving 20 patients with significant internal carotid artery stenosis.
• Patients received either GSNO or saline placebo for 90 minutes.
• Transcatheter Doppler ultrasound monitored embolic signals in the middle cerebral artery before and up to 24 hours after treatment.

Main Results:

• GSNO treatment led to a rapid and significant reduction in embolic signals: 84% at 0-3 hours, 95% at 6 hours, and 100% at 24 hours.
• These reductions were statistically significant compared to the placebo group (P<0.0001, P=0.003, P<0.0001).
• The mean number of embolic signals per hour before treatment was comparable between groups (6.9 in GSNO vs. 7.3 in placebo).

Conclusions:

• Embolization persists in patients with carotid stenosis despite aspirin therapy.
• GSNO demonstrated high efficacy in rapidly decreasing embolic signals in this high-risk patient group.
• Therapeutic effects of GSNO on embolization lasted for 24 hours, despite short administration and half-life.