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International Angiology 2016 April;35(2):148-56


lingua: Inglese

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

Sthefano A. GABRIEL 1, Leila ANTONANGELO 2, Vera L. CAPELOZZI 3, Camila B. BETELI 4, Otacílio Jr DE CAMARGO 1, José L. BRAGA DE AQUINO 5, Roberto A. CAFFARO 6

1 Department of Vascular Surgery, School of Medical Sciences, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil; 2 Central Laboratory, Department of Cytology, School of Medicine, University of Sao Paulo, Hospital das Clinicas, Sao Paulo, Brazil; 3 Department of Pathology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; 4 Department of Vascular Surgery, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil; 5 Department of Surgery Pontifical Catholic, University of Campinas, Sao Paulo, Brazil; 6 Department of Surgery of the Santa Casa de Sao Paulo, School of Medical Sciences, São Paulo, Brazil


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.

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