Selected haemostatic factors in carotid bifurcation plaques of patients undergoing carotid endarterectomy.

OBJECTIVE: To determine the concentration of selected haemostatic factors (HFs): thrombin-antithrombin complexes (TAT), antithrombin (AT), tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1) and D-dimers in carotid bifurcation plaques and to compare plaque composition in different subgroups of patients (mainly those with symptomatic and asymptomatic carotid stenosis). MATERIALS AND METHODS: Thirty-eight consecutive patients (20 symptomatic, 18 asymptomatic) undergoing carotid endarterectomy were enrolled in the study. The concentration of selected HFs in carotid plaques was measured using mainly enzyme immunoassay (ELISA). Simultaneously, the concentration of HFs in plasma was also obtained. RESULTS: Symptomatic plaques contained significantly more TAT complexes (p=0.03). AT was found only in nine out of 38 carotid plaques and was present mainly in symptomatic carotid plaques (n=8/9)(p<0.006). No significant differences were found between symptomatic and asymptomatic carotid plaques with respect to t-PA, PAI-1 and D-dimers concentration. There was an increased concentration of TAT (p<0.001), t-PA (p<0.02) and D-dimers (p<0.02) in carotid plaques of diabetic patients. Patients with coexisting intermittent claudication had elevated levels of D-dimers in carotid plaques (p<0.02). The only positive correlation was demonstrated between the concentration of AT in plasma and carotid plaques (R=0.76; p=0.02). CONCLUSIONS: All the evaluated HFs are the components of a carotid plaque. Symptomatic patients have increased concentration of TAT complexes in a carotid plaque. The symptomatic carotid plaque contains AT more frequently, which correlates positively with AT plasma levels. The most marked changes in the carotid plaque haemostatic composition (expressed by elevated levels of TAT, t-PA and D-dimers) have diabetic patients.