Evaluation of cardiovascular disease markers in patients submitted to carotid artery stenting or endarterectomy

Fittipaldi, Silvia (2012) Evaluation of cardiovascular disease markers in patients submitted to carotid artery stenting or endarterectomy, [Dissertation thesis], Alma Mater Studiorum Università di Bologna. Dottorato di ricerca in Scienze chirurgiche: progetto n. 1 "Metodologie di ricerca nelle malattie vascolari", 24 Ciclo. DOI 10.6092/unibo/amsdottorato/4501.
Documenti full-text disponibili:
[img]
Anteprima
Documento PDF (English) - Richiede un lettore di PDF come Xpdf o Adobe Acrobat Reader
Download (12MB) | Anteprima

Abstract

Introduction. Microembolization during the carotid artery revascularization procedure may cause cerebral lesions. Elevated C-Reactive Protein (hsCRP), Vascular endothelial growth factor (VEGF) and serum amyloid A protein (SAA) exert inflammatory activities thus promoting carotid plaque instability. Neuron specific enolase (NSE) is considered a marker of cerebral injury. Neoangiogenesis represents a crucial step in atherosclerosis, since neovessels density correlates with plaque destabilization. However their clinical significance on the outcome of revascularization is unknown. This study aims to establish the correlation between palque vulnerabilty, embolization and histological or serological markers of inflammation and neoangiogenesis. Methods. Serum hsCRP, SAA, VEGF, NSE mRNA, PAPP-A mRNA levels were evaluated in patients with symptomatic carotid stenosis who underwent filter-protected CAS or CEA procedure. Cerebral embolization, presence of neurologicals symptoms, plaque neovascularization were evaluated testing imaging, serological and histological methods. Results were compared by Fisher’s, Student T test and Mann-Whitney U test. Results. Patients with hsCRP<5 mg/l, SAA<10mg/L and VEGF<500pg/ml had a mean PO of 21.5% versus 35.3% (p<0.05). In either group, embolic material captured by the filter was identified as atherosclerotic plaque fragments. Cerebral lesions increased significantly in all patients with hsCRP>5mg/l and SAA>10mg/l (16.5 vs 2.8 mean number, 3564.6 vs 417.6 mm3 mean volume). Discussion. High hsCRP, SAA and VEGF levels are associated with significantly greater embolization during CAS and to the vulnerabiliy of the plaque. This data suggest CAS might not be indicated as a method of revascularization in this specific group of patients.

Abstract
Tipologia del documento
Tesi di dottorato
Autore
Fittipaldi, Silvia
Supervisore
Co-supervisore
Dottorato di ricerca
Scuola di dottorato
Scienze mediche e chirurgiche cliniche
Ciclo
24
Coordinatore
Settore disciplinare
Settore concorsuale
Parole chiave
atherosclerosis, carotid plaque, vasa vasorum, cerebral lesion, SAA
URN:NBN
DOI
10.6092/unibo/amsdottorato/4501
Data di discussione
17 Aprile 2012
URI

Altri metadati

Statistica sui download

Gestione del documento: Visualizza la tesi

^