Related Experiment Video
Updated: May 30, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Matrix Metalloproteinase-9 and Postoperative Outcomes in Carotid Endarterectomy: A Systematic Review
João Gonçalves-Silva1, Mariana Fragão-Marques1,2, Hugo Ribeiro3,4,5,6
1Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Insights
Elevated matrix metalloproteinase-9 (MMP-9) may predict adverse cardiovascular events after carotid endarterectomy (CEA). Further research is needed to confirm MMP-9 as a reliable biomarker for CEA patients.
Area of Science:
- Vascular Surgery
- Biomarkers
- Cardiovascular Outcomes
Background:
- Carotid endarterectomy (CEA) is a primary treatment for carotid artery stenosis.
- CEA carries risks, including stroke and death.
- Elevated matrix metalloproteinase-9 (MMP-9) may indicate adverse outcomes post-CEA.
Purpose of the Study:
- To systematically review the association between plasma MMP-9 levels and adverse cardiovascular outcomes after CEA.
Main Methods:
- Searched PubMed/MedLine, Scopus, and Web of Science for relevant studies.
- Included five retrospective cohort studies (n=891).
- Assessed study quality using the NHLBI Study Quality Assessment Tool.
Main Results:
- MMP-9 was higher in patients with combined amaurosis fugax, retinal artery occlusion, TIA, and stroke.
- Individual outcomes like TIA or stroke did not consistently correlate with MMP-9.
- Increased MMP-9 was linked to post-CEA cognitive dysfunction.
Conclusions:
- MMP-9 shows potential as a biomarker for predicting cerebrovascular complications after CEA.
- Included studies had a high risk of bias and methodological variability.
- Larger cohorts are needed to validate findings and refine risk stratification.
Abstract:
Background/Objectives: Carotid endarterectomy (CEA) is the treatment of choice for severe symptomatic and asymptomatic carotid artery stenosis. Nonetheless, it carries risks and several complications, including stroke and death. Previous studies have indicated that elevated matrix metalloproteinase-9 (MMP-9) levels may serve as biomarkers for adverse outcomes after CEA. This systematic review investigates the association between plasma MMP-9 levels and adverse cardiovascular outcomes following CEA. Methods: PubMed/MedLine, Scopus and Web of Science were searched for studies assessing the relationship between plasma MMP-9 levels and postoperative outcomes after CEA. Assessment of studies' quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and cross-sectional studies. Results: Five studies were included (n = 891 participants). All five were retrospective cohort studies. MMP-9 was significantly higher in patients who presented with a combination of amaurosis fugax, central retinal artery occlusion, TIA and minor/major stroke at follow-up. However, individual outcomes like TIA or stroke did not consistently correlate with MMP-9 levels. Additionally, increased MMP-9 levels were also associated with cognitive dysfunction post CEA. Conclusions: Despite the potential of MMP-9 levels to serve as a biomarker for predicting postoperative cerebrovascular complications, this review presents limitations, including a high risk of bias in included studies and variability in methodologies. There is a need for further research with larger cohorts to validate these findings and improve risk stratification and management strategies for patients undergoing CEA.
