Analysis of the acute systemic and tissue inflammatory response following carotid endarterectomy.

BACKGROUND

We aimed to investigate the acute systemic and tissue inflammatory response associated with carotid endarterectomy (CEA) and analyze the association between serum and tissue biomarkers and histological features of carotid plaques between symptomatic and asymptomatic patients.

METHODS

We studied 11 patients (6 symptomatic and 5 asymptomatic) with ≥70% internal carotid stenosis treated with CEA. Serum expression of interleukin (IL) 1β, IL-4, IL-6, IL-8, IL-10, metalloproteinase (MMP) 8, MMP-9, tumor necrosis factor-α (TNF-α), high-sensitive C-reactive protein (hs-CRP), and vascular endothelial growth factor (VEGF) were measured in the preoperative period and 1, 6 and 24 hours after CEA. Assessment of tissue biomarkers (IL-1β, IL-4, IL-6, IL-8, IL-10, MMP-8, MMP-9, TNF-α, and VEGF) and histological analyses were performed on carotid plaques.

RESULTS

Peak serum values for MMP-8, MMP-9, IL-6, and IL 10 were observed 6 hours after CEA, whereas for hs-CRP, TNF-α, and VEGF, they were identified 24 hours after the procedure. Symptomatic patients exhibited higher serum concentrations of MMP-8, MMP-9, IL-1β, IL-4, IL-8, hs-CRP and TNF-α and higher tissue concentrations of MMP-8, MMP-9, IL-1β, IL-6 and VEGF than asymptomatic patients. Significant difference was found between symptomatic and asymptomatic patients in tissue IL-6 levels (30.95 pg/mL and 9.33 pg/mL, respectively; P=0.028).

CONCLUSIONS

Systemic and tissue inflammatory response occurs even after CEA, being observed important activity of inflammatory and anti-inflammatory cytokines at 6 and 24 hours after CEA. Symptomatic patients show higher concentrations of serum and tissue biomarkers in comparison to asymptomatic patients.