Oxidative Stress As a Reliable Biomarker of Carotid Plaque Instability: A Pilot Study

Overview

Journal Antioxidants (Basel)

Date 2023 Feb 25

PMID 36830063

Authors

Norbert Svoboda

Karolina Koci

Anna Seidlova

Vaclav Mandys

Jiri Suttnar

Alzbeta Hlavackova

Ondrej Kucerka

David Netuka

Martin Maly

Affiliations

Soon will be listed here.

Abstract

Predicting stroke risk in patients with carotid artery stenosis (CS) remains challenging. Circulating biomarkers seem to provide improvements with respect to risk stratification. Study patients who underwent carotid endarterectomy were categorized into four groups according to symptomatology and compared as follows: symptomatic with asymptomatic patients; and asymptomatic patients including amaurosis fugax (AF) (asymptomatic + AF group) with patients with a transient ischemic attack (TIA) or brain stroke (BS) (hemispheric brain stroke group). Carotid specimens were histologically analyzed and classified based on the American Heart Classification (AHA) standard. As a marker of OS, the plasma levels of malondialdehyde (MDA) were measured. Comparisons of MDA plasma levels between groups were analyzed. : In total, 35 patients were included in the study. There were 22 (63%) patients in the asymptomatic group and 13 (37%) in the symptomatic group. Atheromatous plaque ( 0.03) and old hemorrhage ( 0.05), fibrous plaque ( 0.04), myxoid changes ( 0.02), plaques without hemorrhage ( 0.04), significant neovascularization ( 0.04) and AHA classification ( 0.006) had significant correlations with clinical presentation. There were 26 (74%) patients in the asymptomatic group and 9 (26%) in the hemispheric brain stroke group. Atheromatous plaque ( 0.02), old hemorrhage ( 0.05) and plaques without neovascularization ( 0.02), fibrous plaque ( 0.03), plaques without hemorrhage ( 0.02) and AHA classification ( 0.01) had significant correlations with clinical presentation. There was no significant difference between symptomatic and asymptomatic groups with respect to MDA plasma levels ( = 0.232). A significant difference was observed when MDA plasma levels were compared to asymptomatic + AF and the hemispheric stroke group ( = 0.002). : MDA plasma level correlates with the risk of hemispheric stroke (TIA or BS) and is a reliable marker of plaque vulnerability in carotid artery stenosis.

Citing Articles

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Yuan W, Huo R, Hou C, Bai W, Yang J, Wang T Diagnostics (Basel). 2023; 13(20).

PMID: 37892018 PMC: 10606419. DOI: 10.3390/diagnostics13203196.

References

Re G, Azzimondi G, Lanzarini C, Bassein L, Vaona I, Guarnieri C . Plasma lipoperoxidative markers in ischaemic stroke suggest brain embolism. Eur J Emerg Med. 1997; 4(1):5-9. View

STARY H . Natural history and histological classification of atherosclerotic lesions: an update. Arterioscler Thromb Vasc Biol. 2000; 20(5):1177-8. DOI: 10.1161/01.atv.20.5.1177. View

Verhoeven B, Hellings W, Moll F, Paul De Vries J, de Kleijn D, de Bruin P . Carotid atherosclerotic plaques in patients with transient ischemic attacks and stroke have unstable characteristics compared with plaques in asymptomatic and amaurosis fugax patients. J Vasc Surg. 2005; 42(6):1075-81. DOI: 10.1016/j.jvs.2005.08.009. View

Svoboda N, Bradac O, Mandys V, Netuka D, Benes V . Diagnostic accuracy of DSA in carotid artery stenosis: a comparison between stenosis measured on carotid endarterectomy specimens and DSA in 644 cases. Acta Neurochir (Wien). 2022; 164(12):3197-3202. DOI: 10.1007/s00701-022-05332-5. View

Svoboda N, Voldrich R, Mandys V, Hrbac T, Kesnerova P, Roubec M . Histological Analysis of Carotid Plaques: The Predictors of Stroke Risk. J Stroke Cerebrovasc Dis. 2021; 31(3):106262. DOI: 10.1016/j.jstrokecerebrovasdis.2021.106262. View

Wang Y, Wang G, Rabinovitch P, Tabas I . Macrophage mitochondrial oxidative stress promotes atherosclerosis and nuclear factor-κB-mediated inflammation in macrophages. Circ Res. 2013; 114(3):421-33. PMC: 3946745. DOI: 10.1161/CIRCRESAHA.114.302153. View

Xie M, Tang Q, Nie J, Zhang C, Zhou X, Yu S . BMAL1-Downregulation Aggravates -Induced Atherosclerosis by Encouraging Oxidative Stress. Circ Res. 2020; 126(6):e15-e29. DOI: 10.1161/CIRCRESAHA.119.315502. View

Howard D, van Lammeren G, Rothwell P, Redgrave J, Moll F, de Vries J . Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk. Stroke. 2014; 46(1):182-189. PMC: 4285579. DOI: 10.1161/STROKEAHA.114.007221. View

Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J . Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results. Stroke. 2006; 37(3):818-23. DOI: 10.1161/01.STR.0000204638.91099.91. View

10.

Johnston J, Horne S, Harding K, Benson E . Evaluation of the 1-methyl-2-phenylindole colorimetric assay for aldehydic lipid peroxidation products in plants: malondialdehyde and 4-hydroxynonenal. Plant Physiol Biochem. 2007; 45(2):108-12. DOI: 10.1016/j.plaphy.2007.01.011. View

11.

Hajsl M, Hlavackova A, Broulikova K, Sramek M, Maly M, Dyr J . Tryptophan Metabolism, Inflammation, and Oxidative Stress in Patients with Neurovascular Disease. Metabolites. 2020; 10(5). PMC: 7281607. DOI: 10.3390/metabo10050208. View

12.

Shaalan W, Cheng H, Gewertz B, McKinsey J, Schwartz L, Katz D . Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. J Vasc Surg. 2004; 40(2):262-9. DOI: 10.1016/j.jvs.2004.04.025. View

13.

Sigala F, Kotsinas A, Savari P, Filis K, Markantonis S, Iliodromitis E . Oxidized LDL in human carotid plaques is related to symptomatic carotid disease and lesion instability. J Vasc Surg. 2010; 52(3):704-13. DOI: 10.1016/j.jvs.2010.03.047. View

14.

Hetterich H, Webber N, Willner M, Herzen J, Birnbacher L, Hipp A . AHA classification of coronary and carotid atherosclerotic plaques by grating-based phase-contrast computed tomography. Eur Radiol. 2015; 26(9):3223-33. DOI: 10.1007/s00330-015-4143-z. View

15.

Ni H, Song Y, Lin Y, Cao B, Wang D, Zhang Y . Dissociating nNOS (Neuronal NO Synthase)-CAPON (Carboxy-Terminal Postsynaptic Density-95/Discs Large/Zona Occludens-1 Ligand of nNOS) Interaction Promotes Functional Recovery After Stroke via Enhanced Structural Neuroplasticity. Stroke. 2019; 50(3):728-737. DOI: 10.1161/STROKEAHA.118.022647. View

16.

Fisher M, Paganini-Hill A, Martin A, Cosgrove M, Toole J, Barnett H . Carotid plaque pathology: thrombosis, ulceration, and stroke pathogenesis. Stroke. 2005; 36(2):253-7. DOI: 10.1161/01.STR.0000152336.71224.21. View

17.

Saba L, Anzidei M, Cavallo Marincola B, Piga M, Raz E, Bassareo P . Imaging of the carotid artery vulnerable plaque. Cardiovasc Intervent Radiol. 2013; 37(3):572-85. DOI: 10.1007/s00270-013-0711-2. View

18.

Puig N, Jimenez-Xarrie E, Camps-Renom P, Benitez S . Search for Reliable Circulating Biomarkers to Predict Carotid Plaque Vulnerability. Int J Mol Sci. 2020; 21(21). PMC: 7662861. DOI: 10.3390/ijms21218236. View

19.

Andrews J, Fayad Z, Dweck M . New methods to image unstable atherosclerotic plaques. Atherosclerosis. 2018; 272:118-128. PMC: 6463488. DOI: 10.1016/j.atherosclerosis.2018.03.021. View

20.

Ohara T, Toyoda K, Otsubo R, Nagatsuka K, Kubota Y, Yasaka M . Eccentric stenosis of the carotid artery associated with ipsilateral cerebrovascular events. AJNR Am J Neuroradiol. 2008; 29(6):1200-3. PMC: 8118845. DOI: 10.3174/ajnr.A0997. View