Carotid atherosclerosis, a chronic inflammatory disease, is a risk factor for ischemic stroke, the third cause of death in developed countries. Degree of stenosis, evaluated by imaging techniques, is used to predict the risk of future cerebrovascular events and it is considered the most validated parameter to select asymptomatic patients eligible for carotid endarterectomy (CEA). However it has been observed that a subset of patients, particularly women, with lesions at an early stage of development undergoes sudden death. Therefore there is the need of more sensitive tools, that in addition to imaging techniques permit to identify plaques at high risk of clinical events. The identification of suitable biomarkers could provide a useful adjunctive criterion to ensure better risk stratification and optimize management of patients. The aim of this project is to identify inflammatory and immunological molecules in the blood of patients with carotid atherosclerosis as biomarkers of plaque activity associated with plaque morphology evaluated by ultrasound. Patients will be divided into two groups according to the presence or not of indication for CEA. A Doppler carotid ultrasound study will be used to determine a computer assisted (quantitative) index named Gray-Scale median (GSM). This score will be used to assess the carotid plaque echogenicity, that is associated to plaque characteristics. The panel of soluble molecules will include: 1) CD40L a protein by activated T lymphocytes and platelets; 2) endoglin, a biomarker of neoangiogenesis and endothelial dysfunction; 3) CD163 and CD14, two macrophage biomarkers, 4) E-selectin, an adhesion molecule expressed on endothelial cells; 5) MCP-1, one of the key chemokines that regulate migration and infiltration of monocytes/macrophages; 6) Adiponectin, a novel adipocyte-specific protein, which plays a role in the development of atherosclerosis.
