Page 96 - Read Online

Mueller et al. Vessel Plus 2018;2:13 I http://dx.doi.org/10.20517/2574-1209.2018.19 Page 3 of 10

For MES detection, bilateral transcranial doppler (TCD) recording was performed during 60 min. In
symptomatic patients, this examination was performed within 7 days after stroke onset and within 10 days
when asymptomatic. We used a standard protocol as described elsewhere . Embolic signal interpretation
[13]
was done manually by an experienced ultrasonographer based on the criteria of the International Consensus
group on Microembolus Detection [15,16] . Detection of at least 1 MES ipsilateral of the stenosis resulted in a
positive exam, and those patients were defined as MES+.

Imaging
Symptomatic patients underwent a CT scan with contrast angiography of vessels of the neck and brain.
Additionally, MRI study was performed with T1, T2, diffusion weighted (DWI) and fluid attenuated inversion
recovery (FLAIR) sequences.

Plasmatic biomarkers
Venous blood samples taken on the day of FDG-PET-CT were analyzed for 111 patients. Plasma levels of
18
MMP-2, -3, -8, -9, IL-1, IL-6, intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule
(VCAM)-1, P-selectin, E-selectin, tumor necrosis factor α (TNFα), RANTES, monocyte chemoattractant
protein (MCP)-1, were performed using a bioplex 200 array reader (Bio-Rad Laboratories; Hercules, CA,
TM
USA) with Luminex MAP Technology (Luminex Corporation, Austin, TX, USA). MPO levels were
measured using the colorimetric enzyme-linked immunosorbent assay (ELISA), a commercial kit purchased
from R&D Systems (Minneapolis, MN, USA), according to manufacturer’s instructions. The lp-PLA2
concentration (mass) was measured using PLAC Test ELISA Kit.

Statistical analysis
All continuous variables were summarized by mean and median. For testing of significant difference
between groups, the U-Mann-Whitney test was applied. Receiver operating characteristic (ROC) curve
analysis was used to determine the prognostic accuracy of the plasmatic biomarkers with respect to TBR
values and presence or absence of MES. For correlation we used Spearman’s rho method. Statistical analysis
was performed using MedCalc (MedCalc Software, Ostend, Belgium) software.

RESULTS
From 2009 to 2015, 111 patients were analyzed. Fifty-four patients presented with symptomatic and 57 with
asymptomatic carotid disease. All demographical data of the patients are summarized in Table 1. The CV risk
factor profile was similar in the two groups, for the exception of degree of stenosis which was significantly
higher in symptomatic patients. The male gender predominated in both groups.

MES
MES detection could be carried out in 107 patients. In 4 patients the investigation was not possible because
of insufficient temporal bone window. Nineteen of 107 (18%) patients presented microembolic signals
ipsilaterally during TCD recording. The mean number of emboli was 10 (range 1-50). The proportion of
MES+ patients was higher in the symptomatic (26%, n = 14/54) when compared to the asymptomatic group
(9%, n = 5/57; P = 0.01) [Table 1].

18 FDG-PET
One hundred eleven patients with 111 carotid plaques were analyzed. Hundred-one plaques presented
with partial calcification whereas 10 showed exclusively a soft component on CTA. FDG uptake was
18
significantly higher in the symptomatic group as compared to the asymptomatic one (TBR: median 2.1
vs. 1.8, P = 0.002) [Table 1]. When confronting presence of MES to FDG uptake, those plaques producing
18