# The Association of Histological Signs of Plaque Instability with Low eGFR, Higher Neutrophil-to-Lymphocyte Ratio, and Lower Serum MCP-1 Levels in Carotid Endarterectomy Patients—A Single-Center, Prospective Cohort Study

## TL;DR

This study finds that unstable carotid artery plaques are linked to poor kidney function, higher neutrophil/lymphocyte ratios, and lower MCP-1 levels in patients undergoing surgery.

## Contribution

Identifies novel associations between plaque instability markers and systemic biomarkers like eGFR, neutrophil/lymphocyte ratio, and MCP-1 in carotid endarterectomy patients.

## Key findings

- Patients with complicated plaques had significantly lower eGFR values compared to those without.
- Bleeding and ulceration in carotid plaques correlated with a higher neutrophil/lymphocyte ratio.
- Lower serum MCP-1 levels were observed in patients with massive inflammatory infiltrate in plaques.

## Abstract

Background: Histological signs of carotid atheromatous plaque vulnerability, such as hemorrhage, neovascularization, atherothrombosis, and ulceration, develop against an unstable biological background. Declining renal function contributes to atherosclerotic progression and worsens cardiovascular outcomes. Methods: In a single-center prospective cohort study, we studied 41 endarterectomized patients with severe carotid atherosclerosis. The histological samples were stained with H&E to assess morphology and immunohistochemically labeled with antibodies for CRP and MMP-9 proteins. Complete blood count, the presence of serum biomarkers hsCRP, oxLDL, MCP-1, and MMP-9, and the level of eGFR were determined. Results: Twenty-eight patients with complicated plaques had significantly lower eGFR values: 79.5 (24–110) vs. 94 (69–114) (p = 0.004). Patients with eGFR > 90 mL/min/1.73m2 had a higher incidence of intraplaque hemorrhage and histologic complications of any cause (p = 0.012 and p = 0.003). Patients with bleeding and ulceration from the carotid plaque had a higher neutrophil/lymphocyte ratio. Significantly lower levels of MCP-1 were found in the serum of patients with massive inflammatory infiltrate of the carotid plaques, while serum levels of biomarkers like hsCRP, MMP-9, and oxLDL did not show differences in cases with plaque vulnerability. Conclusions: Signs of plaque vulnerability are associated with reduced renal function, a higher neutrophil/lymphocyte ratio, and lower serum levels of MCP-1 in advanced carotid artery stenosis disease.