1. Preventing Stroke Is No Joke Identifying Novel Markers of Carotid Plaque Instability – Plotting The Trail of Destruction MK Salem, NJM London, RD Sayers, MJ Bown, AR Naylor Vascular Surgery Group, Department of Cardiovascular Sciences, University of Leicester Introduction Stroke 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 brain The Paradox Surgery 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 patients Research Aims Devise a new accurate and safe diagnostic screening tool for patients with carotid artery disease to assess the risks of having a major stroke. Methods Patients 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 term Result Over 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 plaque 2. US analysis Four novel features on US analysis have been shown to differentiate between stable and unstable plaques 3. Gene expression profiling - Illumina DASL profiling 128 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 plaques Discussion Preliminary 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
