Key result
Symptomatic patients undergoing carotid endarterectomy had significantly higher expression of MMP-9 in CD68 cells within carotid plaques compared to asymptomatic patients (86% vs. 25%, p=0.014).
Why the study?
The study aimed to analyse histological characteristics and MMP-9 expression in carotid plaques of patients undergoing CEA, and investigate their correlation with preoperative symptoms and MRI features.
Do MRI features and MMP-9 expression correlate with clinical symptoms in patients with carotid artery stenosis undergoing carotid endarterectomy?
Observational (n=15)
Do MRI features and MMP-9 expression correlate with clinical symptoms in patients with carotid artery stenosis undergoing carotid endarterectomy?
Absolute Event Rate: 86% vs 25%
p-value: p=0.014
MMP-9 expression is significantly higher in carotid plaques of symptomatic patients, and MRI can reliably differentiate unstable from stable plaques.
MMP-9 expression in carotid plaques was associated with symptoms; leaves open whether it aids risk stratification or guides therapy.
Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR:1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%, p =0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression, p =0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance ( p =0.064 and p =0.132, p =0.360 and p =0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA. Trial Registration: This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832 Keywords: atherosclerosis, carotid endarterectomy, unstable plaque, magnetic resonance imaging, matrix metalloproteinase.
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Sef et al. (2021) conducted an observational in Carotid artery stenosis (n=15). Symptomatic carotid artery stenosis vs. Asymptomatic carotid artery stenosis was evaluated on Highest expression of MMP-9 in CD68 cells within the plaque (p=0.014). Symptomatic patients undergoing carotid endarterectomy had significantly higher expression of MMP-9 in CD68 cells within carotid plaques compared to asymptomatic patients (86% vs. 25%, p=0.014).
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