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The Role of Magnetic Resonance Imaging and the Expression of MMP-9 Protein in the Analysis of Carotid Atherosclerotic Plaques in Patients Undergoing Carotid Endarterectomy: A Prospective Pilot Study
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  • Davorin Sef,
  • Milan Milosevic,
  • Marin Ostric,
  • Tomislav Mestrovic,
  • Bojan Jernej,
  • Slavica Kovacic,
  • Miljenko Kovacevic,
  • Anita Skrtic,
  • Vinko Vidjak
Davorin Sef

Corresponding Author:[email protected]

Author Profile
Milan Milosevic
Marin Ostric
Tomislav Mestrovic
Bojan Jernej
Slavica Kovacic
Miljenko Kovacevic
Anita Skrtic
Vinko Vidjak


Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR:1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%, p=0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression, p=0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance (p=0.064 and p=0.132, p=0.360 and p=0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA.
Trial Registration: This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832
Keywords: atherosclerosis, carotid endarterectomy, unstable plaque, magnetic resonance imaging, matrix metalloproteinase.
2021Published in Reviews in Cardiovascular Medicine volume 22 issue 4 on pages 1611. 10.31083/j.rcm2204167