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C-reactive protein and embolization during carotid artery stenting. A serological and morphological study
G Faggioli1, S Fittipaldi, R Pini
1Department of Specialistic Surgery and Anaesthesiological Sciences, Ospedale S. Orsola, University of Bologna, Bologna, Italy. gianluca.faggioli@unibo.it
Insights
High-sensitivity C-Reactive Protein (hsCRP) levels correlate with increased embolization during carotid artery stenting (CAS). Elevated hsCRP and dishomogenous plaques significantly increase debris, suggesting CAS may not be ideal for all patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarkers in Atherosclerosis
Background:
- High-sensitivity C-Reactive Protein (hsCRP) is linked to vulnerable carotid plaques.
- The impact of hsCRP on carotid revascularization outcomes, specifically embolization during carotid artery stenting (CAS), remains unclear.
Purpose of the Study:
- To investigate the correlation between hsCRP levels and embolization during CAS.
- To assess the influence of hsCRP and plaque characteristics on embolic material during CAS.
Main Methods:
- Symptomatic patients undergoing CAS with distal protection filters were enrolled.
- Serum hsCRP levels were measured pre-CAS, categorizing patients into Class I (<5 mg/l) and Class II (≥5 mg/l).
- Plaque homogeneity was assessed by ultrasound; embolic debris on filters was quantified by surface involvement (SI) and pore occlusion (PO).
Main Results:
- All filters showed microscopic debris; Class II patients had higher PO (33.3% vs. 22.9%, p=0.049).
- Patients with high hsCRP (Class II) and dishomogenous plaques exhibited significantly greater SI and PO compared to Class I with homogenous plaques (p<0.05).
- Embolic material consisted of atherosclerotic plaque fragments and platelet aggregates, similar between groups.
Conclusions:
- Elevated hsCRP levels are associated with increased embolization during CAS in symptomatic patients.
- The combination of high hsCRP and dishomogenous plaque exacerbates embolization.
- These findings suggest that CAS might not be the optimal revascularization strategy for all patients with high hsCRP and dishomogenous carotid plaques.
Introduction:
High-sensitivity C-Reactive Protein (hsCRP) levels are correlated with vulnerable carotid plaques, although their impact on the outcome of carotid revascularization is unknown. The aim of our study was to investigate the correlation between hsCRP and embolization during carotid artery stenting (CAS).
Methods:
Patients with symptomatic carotid stenosis were submitted to CAS with distal protection filters. Serum hsCRP was analysed prior to CAS and patients were divided into two groups: Class I, patients presenting hsCRP < 5 mg/l and, Class II, patients presenting hsCRP≥5 mg/l. Plaques were categorised by ultrasound grey scale measurement as homogenous and dishomogenous. Afterwards CAS filters were analyzed microscopically and ultrastructurally to determine the type and the amount of debris present, based on percentage of surface involvement (SI) and pore occluded (PO) by embolic material.
Results:
Fourteen patients underwent uneventful CAS, with a mean hsCRP of 11.5±18.4 mg/l. Eight patients were in Class I and six in Class II. All filters had microscopic debris. SI was 25.4% in Class I and 33.3% in Class II (p=ns), PO 22.9% and 33.3% respectively (p=0.049). Patients in Class II who also had a dishomogenous plaque showed greater SI and PO compared with patients in Class I with homogenous plaque (35.0% vs. 21.8% and 40.4% vs. 22.7% respectively, p<0.05). Microscopically embolic material was identified as atherosclerotic plaque fragments and platelet aggregates and was similar in both groups.
Discussion:
High hsCRP levels are associated with significantly greater embolization during CAS in symptomatic patients, particularly in dishomogenous plaque. Although these results need further investigation due to the limited number of enrolled patients, this study suggests that CAS may not be indicated as a method of carotid revascularization in this setting.
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