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3 . 2025

Morphological and biochemical characteristics of atherosclerotic plaques in symptomatic and asymptomatic carotid stenosis

Abstract

Background. Carotid artery stenosis, especially hemodynamically significant, is a major risk factor for ischemic stroke. While symptomatic carotid stenosis (SCS) clearly requires surgical intervention, the treatment of asymptomatic carotid stenosis (ACS) remains controversial. Current guidelines emphasize the importance of identifying unstable or “vulnerable” plaques prone to rupture and subsequent thromboembolic complications.

Objective. The aim of this study was to investigate morphological and biochemical differences between stable and unstable atherosclerotic plaques in patients with SCS and ACS, paying special attention to the role of extracellular matrix (ECM) components, glycocalyx molecules, and matrix metalloproteinases (MMPs) in plaque destabilization.

Patients and methods. The study enrolled a total of 28 patients who underwent carotid endarterectomy. They were divided into symptomatic (n=11) and asymptomatic (n=17) groups. Plaque samples were obtained intraoperatively and analyzed using histopathological and biochemical methods. Morphological assessment included the presence of neovascularization, inflammation, and the integrity of the fibrous cap. Biochemical analysis focused on the expression of ECM components (versican, syndecan, decorin) and MMP activity (MMP-1, MMP-2, MMP-9, MMP-12) using Western blotting and zymography. Preoperative ultrasound was used to evaluate plaques based on their echogenicity and structural features. Statistical analysis was performed to compare plaque characteristics between groups and identify correlations between ECM components and MMP activity.

Results. Unstable plaques, regardless of the presence of symptoms, exhibited neovascularization and a significant decrease in the levels of syndecan and decorin (p<0.05), which play a key role in maintaining vascular integrity and regulating inflammation. Increased MMP activity, particularly that of MMP-9, was observed in symptomatic plaques, indicating its role in plaque destabilization and, as a result, an increased risk of stroke. Interestingly, isolated symptomatic plaques did not have signs of neovascularization, but were characterized by pronounced calcification and low MMP-1 activity, which may indicate heterogeneity of plaque phenotypes. A positive correlation was found between the content of versican in plaques and the activity of MMP-9 and MMP-12 (r=0.809 and r=0.625, respectively). The obtained findings suggest that plaque stability is determined by a complex interaction of ECM remodeling, inflammation and angiogenesis.

Conclusion. This retrospective study demonstrated that morphological and biochemical markers such as neovascularization, ECM composition, and MMP activity provide important information about plaque stability and stroke risk in patients with carotid stenosis. The results confirm the feasibility of using these markers, along with the degree of stenosis, to make decisions about surgical treatment and improve stroke prevention strategies.

Keywords: carotid stenosis; atherosclerotic plaques; extracellular matrix; neovascularization; matrix metalloproteinases; stroke prevention

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflict of interest.

Authors’ contribution. Lukin S.V. – concept, planning, instrumental diagnostics, clinical observations, endarterectomy operations, discussion of results, writing an article; Voronkina I.V. – concept, biochemical studies, discussion of results; Smagina L.V. – biochemical studies; Pigarevsky P.V. – morphological studies, discussion of results; Maltseva S.V. – morphological studies; Denisenko A.D. – concept, discussion of results; Tanyansky D.A. – concept, planning, coordination of studies, discussion of results; Gurevich V.S. – concept, discussion of results; Svetlikov A.V. – concept, planning, endarterectomy operations, coordination of studies, discussion of results.

For citation: Lukin S.V., Voronkina I.V., Smagina L.V., Pigarevsky P.V., Maltseva S.V., Denisenko A.D., Tanyansky D.A., Gurevich V.S., Svetlyakov A.V. Morphological and biochemical characteristics of atherosclerotic plaques in symptomatic and asymptomatic carotid stenosis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (3): 44–52. DOI: https://doi.org/10.33029/1027-6661-2025-31-3-44-52

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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