Coagulation activation and ultrasound characteristics in patients with carotid artery disease

被引:5
作者
Kolbel, Tilo [1 ]
Goncalves, Isabel [2 ]
Dias, Nuno [1 ]
Strandberg, Karin
Acosta, Stefan [1 ]
Gottsater, Anders [1 ]
机构
[1] Malmo Univ Hosp, Vasc Ctr, S-20502 Malmo, Sweden
[2] Malmo Univ Hosp, Dept Cardiol, S-20502 Malmo, Sweden
基金
英国医学研究理事会;
关键词
Carotid artery stenosis; APC-PCI; Plaque morphology; Thrombin activation; Stroke; Ultrasound; PROTEIN-C-INHIBITOR; ATHEROSCLEROTIC PLAQUE RUPTURE; BLOOD-COAGULATION; AORTIC-ANEURYSMS; SURGERY-TRIAL; ENDARTERECTOMY; STENOSIS; COMPLEX; MARKERS; SYMPTOMS;
D O I
10.1016/j.thromres.2009.07.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Elevated levels of markers for thrombin activation are associated with plaque echogenicity and degree of stenosis in patients with carotid artery stenosis. The Activated Protein C-Protein C Inhibitor (APC-PCI) complex reflects activation of the Protein C system and is a measure of thrombin generation. The aim of the present study was to examine APC-PCI complex in patients undergoing thrombendartherectomy for carotid artery stenosis, and to relate the findings to clinical characteristics and plaque morphology as determined by ultrasound. Materials and Methods: Blood was obtained from 125 patients (39 female, median age 71 years) with carotid artery stenosis admitted from September 2005 to May 2007. The APC-PCI complex was measured using a sandwich immunofluorometric method and compared to an age-and sex-matched healthy control-group. Clinical and demographic characteristics, routine laboratory markers and ultrasound characteristics were analysed using univariate and multivariate analysis. Results: APC-PCI complex concentration was significantly increased in patients with carotid artery stenosis (median 0.21 mu g/L; 10th to 90th percentile 0.15-0.36) compared to a healthy control-group (0.19 mu g/L; 0.11-0.31; P = .009). There was no significant difference in APC-PCI-values between asymptomatic (n = 48) and symptomatic (n = 77) patients with carotid artery stenosis (0.22 vs. 0.20 mu g/L; p = 0.626). Patients with minor stroke (n = 31) had a higher median APC-PCI-concentration (0.27 mu g/L; 0.15-0.63) than patients with amaurosis fugax (0.19 mu g/L; 0.15-0.36) or transient ischemic attack (0.21 mu g/L; 0.12-0.36) (p = 0.016). No association was found between APC-PCI-values and the degrees of carotid artery stenosis or the time from the latest neurological symptoms to blood sampling. Patients with echolucent plaques had significantly lower APC-PCI concentrations (0.20 mu g/L; 0.14-0.35 vs. 0.24 mu g/L; 0.15-0.60; p = 0.043), according to the Gray-Weale classification. Conclusions: Patients with carotid artery disease exhibit increased concentrations of APC-PCI compared to a healthy control-group, particularly those patients with echogenic plaques, who have significantly higher APC-PCI levels than patients with echolucent plaques. (C) 2009 Elsevier Ltd. All rights reserved.
引用
收藏
页码:171 / 177
页数:7
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