Abstract
Atherosclerosis is responsible for 20% of ischemic strokes, and the plaques from the internal carotid artery the most frequently involved. Lipoproteins play a key role in carotid atherosclerosis since lipid accumulation contributes to plaque progression and chronic inflammation, both factors leading to plaque vulnerability. Carotid revascularization to prevent future vascular events is reasonable in some patients with high-grade carotid stenosis. However, the degree of stenosis alone is not sufficient to decide upon the best clinical management in some situations. In this context, it is essential to further characterize plaque vulnerability, according to specific characteristics (lipid-rich core, fibrous cap thinning, intraplaque hemorrhage). Although these features can be partly detected by imaging techniques, identifying carotid plaque vulnerability is still challenging. Therefore, the study of circulating biomarkers could provide adjunctive criteria to predict the risk of atherothrombotic stroke. In this regard, several molecules have been found altered, but reliable biomarkers have not been clearly established yet. The current review discusses the concept of vulnerable carotid plaque, and collects existing information about putative circulating biomarkers, being particularly focused on lipid-related and inflammatory molecules.
Highlights
Stroke is a leading cause of death, disability, and dementia worldwide
The identification of biomarkers will help in answering the two key questions that arise whenever we find an atherosclerotic plaque in the carotid artery or in the intracranial circulation in the setting of an ischemic stroke: (1) Does a correlation exist between the plaque and the stroke pathogenesis? (2) What is the risk of stroke recurrence? The second question is extremely important in assessing whether a medical treatment alone will be sufficient to prevent new events or whether a revascularization therapy is necessary
This review focuses on biomarkers that are related to inflammation and lipids
Summary
Stroke is a leading cause of death, disability, and dementia worldwide. It represents the third cause of mortality in western countries. Inflammation and lipid-related molecules may diffuse from the lesion milieu and are released into the systemic circulation [13]. This phenomenon brings us the opportunity to determine which molecules are the major predictors of atherosclerotic burden, ischemic stroke, plaque vulnerability, and disease progression. This review discusses the concept of vulnerable carotid plaque, and it presents the existing information on the putative circulating biomarkers for carotid atherosclerosis, with a focus on lipid-related and inflammatory molecules. This review discusses the relationship between these biomarkers and the occurrence/recurrence of symptoms, as well as the putative use of these biomarkers in the clinical practice
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