Search for Reliable Circulating Biomarkers to Predict Carotid Plaque Vulnerability

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.

Vulnerable Plaque Is More Prevalent in Male Individuals at High Risk of Stroke: A Propensity Score-Matched Study

“…With the aging of the population, the onging high incidence of risk factors and inadequate management, the burden of stroke is increasing year by year (Wu et al, 2019). Approximately 80% of all strokes are ischemic and carotid artery atherosclerosis accounts for at least 20% of all ischemic strokes (Prasad, 2015;Puig et al, 2020).…”

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

“…Atherosclerotic lesions in the carotid bifurcation can lead to cerebral embolization by rupture of the fibrous cap, which can expose intensely thrombogenic materials to blood elements [44]. The molecular changes in the carotid vessel wall during plaque formation have been studied extensively before, the data showed diversified and complex systematic changes in carotid plaques.…”

“…Furthermore, its automatic evaluation needs further investigation and evolution in machine learning and AI development. There is also a great demand for studies on circulating biomarkers based on the recognition of the exact molecular mechanisms of carotid plaque instability, which could provide additional help to predict the risk of atherothrombotic stroke in daily clinical practice [44].…”

Circulating Biomarkers Reflecting Destabilization Mechanisms of Coronary Artery Plaques: Are We Looking for the Impossible?

“…Apart from various imaging modalities, multiple biomarkers were proposed to identify the presence of vulnerable plaques or plaques at different stages of remodeling. A logic behind measurement of biomarkers in blood that reflect the presence of vulnerable plaque is dual [19]. Certain molecules could arise as a consequence of leakage from unstable plaques, whereas others could merely indicate that a patient is susceptible to the development of a vulnerable plaque as those molecules are implicated in plaque destabilization.…”