Carotid Artery Plaque, Mannose-Binding Lectin Complement Pathway
Conditions
Keywords
carotid artery atherosclerosis, alternative complement pathway
Brief summary
The study is aimed to investigate the possible role of lectin pathway - an alternative pathway of complement activation - in affecting stability of carotid atherosclerotic plaques and the possible correlations with clinical neurologic features.
Detailed description
In addition to the known hemodynamic criteria, instable carotid plaques can be responsible for brain ischemia, therefore is paramount to identify preoperatively possible markers of plaque instability. The study is aimed to investigate the possible role of lectin pathway - an alternative pathway of complement activation - in affecting stability of carotid atherosclerotic plaques and the possible correlations with clinical neurologic features. Study population will include 40 patients with internal carotid artery stenosis \>=70% (assessed by echocolordoppler), symptomatic or asymptomatic, surgically treated by endoarterectomy. Removed plaques will be evaluated by histologic exam and immunofluorescence for ficolins 1-2-3 and Mannose Binding Lectin (MBL). Plasma samples will be used for ELISA test of lectin pathway complement activation.
Interventions
PROCEDURECarotid endoarterectomy
Surgical removal of carotid bifurcation plaque and arterial repair (direct suture or patch)
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* patients undergone elective or urgent carotid endoarterectomy (CEA) for internal carotid stenosis \>70% (assessed by velocimetric criteria) with or without neurologic symptoms
Exclusion criteria
* recent (\<20 days) major/minor stroke with positive CT scan * absolute contraindications to surgery (cardiac, respiratory, anesthesiologic risk)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| lectine pathway of complement activation in carotid plaques | preoperative | assessment of association between plasmatic levels of complement activators and plaque instability (histologic index). Protein plasma levels will be assessed as optical density. Plaque instability will be quantified by a vulnerability score that combines four different histological parameters according to their quartile distribution (Fumagalli et al., Frontiers Immunology 2017). Their association will be analyzed as odds ratio (95%-CI) by a Fisher test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| focal neurologic symptoms and plasmatic levels of complement activators | preoperative, postoperative day 3, 3 months after surgery | Correlation of onset of focal neurologic symptoms (TIA, any stroke) due to carotid stenosis and peripheral plasma levels of complement activators. Neurological exam + CT or MNR will be used as clinical measurement tool |
| focal neurologic symptoms and histologic index of plaque instability | through study completion (average 1 year) | correlation of onset of focal neurologic symptoms (TIA, any stroke) due to carotid stenosis and histologic index for plaque instability. Protein plasma levels will be assessed as optical density. Plaque instability will be quantified by a vulnerability score that combines four different histological parameters according to their quartile distribution (Fumagalli et al., Frontiers Immunology 2017). |
Outcome results
None listed