This document discusses the development of a new diagnostic tool aimed at identifying patients with carotid artery disease at high risk of stroke. The study analyzes various diagnostic tests, including ultrasound and gene expression profiling, to differentiate between stable and unstable plaques. Preliminary findings suggest that this model could help target immediate interventions for at-risk patients, although further data is needed for statistical validation.

1. Preventing Stroke Is No JokeIdentifying Novel Markers of Carotid Plaque Instability – Plotting The Trail of DestructionMK Salem, NJM London, RD Sayers, MJ Bown, AR NaylorVascular Surgery Group, Department of Cardiovascular Sciences, University of LeicesterIntroductionStroke affects 110,000 people per year at a cost of £3billion to the NHS.It is a leading cause of death and permanent disability.Many strokes arise from debris originating in the carotid artery (main neck artery) plaque, which can block vessels further up in the brainThe ParadoxSurgery to remove the plaque in the carotid artery is one of the main treatment modalities,though this very operation that is done to prevent strokes in the long term can cause a stroke in a small but significant number of patientsResearch AimsDevise a new accurate and safe diagnostic screening tool for patients with carotid artery disease to assess the risks of having a major stroke. MethodsPatients having surgery for carotid disease undergo a series of tests including Ultrasound Scans, Brain Arterial Doppler monitoring, and Gene Expression Profiling on blood and plaque tissue.Scores for each test are analysed to show which tests and expressed genes are consistently associated with highly unstable plaques, likely to cause a major stroke in the short termResultOver 220 patients have been recruited to the study. 1. Plaque Histology All plaques are histologically graded by two blinded trained histopathologists using a validated scoring system.. This is the gold standard for determining an unstable plaque2. US analysis Four novel features on US analysis have been shown to differentiate between stable and unstable plaques3. Gene expression profiling - Illumina DASL profiling128 differentially expressed genes between unstable and stable plaques on histology - Common pathways and expressed protein products to be looked for after validation.4. Arterial Doppler monitoring Patients who have spontaneous emboli (clots from plaque) detected are twice as likely to have unstable plaquesDiscussionPreliminary analysis suggests this new scoring model can identify patients with carotid artery disease at high risk who need immediate intervention, though further numbers are required to reach statistical significance. Email: ms447@le.ac.uk Tel: 01162523252