Publication: C-Reactive protein and embolization during carotid artery stenting. A serological and morphological study
Authors
Faggioli, G. ; Fittipaldi, S. ; Pini, R. ; Beltrandi, E. ; Mauro, R. ; Freyrie, A. ; Rapezzi, C. ; Stella, A. ; Pasquinelli, G.
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Publisher
F. Hernández y Juan F. Madrid. Murcia: Universidad de Murcia, Departamento de Biología Celular e Histología
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Description
Abstract
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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