Increased endothelial cell apoptosis in symptomatic high-grade carotid artery stenosis: Preliminary data

Objective. Endothelial cell (EC) apoptosis has been associated with thrombus formation on all eroded atherosclerotic plaque surface. Alongside plaque rupture, it may constitute another mechanism of plaque destabilisation. We investigated whether EC apoptosis also may be involved in plaque destabilisation in high-grade internal carotid artery (ICA) stenosis. Methods. We compared the degree of EC apoptosis in carotid endartercctomy specimens from n=38 patients undergoing surgery for high-grade ICA stenosis (>= 70%; n=19 clinically asymptomatic; n=19 symptomatic). The total number of endothelial cells (ECs) and apoptotic cells were determined using CD31 immunohistochemistry and the TdT dUTP nick end-labeling (TUNEL) method respectively. Results. Overall, EC apoptosis was a rare finding. The median percentage of apoptotic ECs was 0.0% (0.0-0.7%) in asymptomatic and 0.5% (0.0-7.3%) in symptomatic plaques (p=0.015, Mann-Whitney U test). No difference was observed between ruptured and unruptured plaque (0.0% [0.0-6.0%] vs 0.0% [0.0-5.7%]; p=0.446). Conclusions. Our results indicate that TUNEL-detected EC apoptosis is rare in carotid plaque from patients with > 70% stenosis.