PT  - JOURNAL ARTICLE
AU  - J A Kinsella
AU  - W O Tobin
AU  - G F Kavanagh
AU  - J S O'Donnell
AU  - R T McGrath
AU  - S Tierney
AU  - T M Feeley
AU  - B Egan
AU  - D O'Neill
AU  - D R Collins
AU  - T Coughlan
AU  - J A Harbison
AU  - C P Doherty
AU  - P Madhavan
AU  - D J Moore
AU  - S M O'Neill
AU  - M P Colgan
AU  - M Saqqur
AU  - R P Murphy
AU  - N Moran
AU  - G Hamilton
AU  - D J H McCabe
TI  - Increased thrombin generation potential in symptomatic versus asymptomatic moderate or severe carotid stenosis and relationship with cerebral microemboli
AID  - 10.1136/jnnp-2013-307556
DP  - 2015 Apr 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 460--467
VI  - 86
IP  - 4
4099  - http://jnnp.bmj.com/content/86/4/460.short
4100  - http://jnnp.bmj.com/content/86/4/460.full
SO  - J Neurol Neurosurg Psychiatry2015 Apr 01; 86
AB  - Introduction The importance of thrombin generation in the pathogenesis of TIA or stroke and its relationship with cerebral microembolic signals (MES) in asymptomatic and symptomatic carotid stenosis has not been comprehensively assessed. Methods Plasma thrombin generation parameters from patients with moderate or severe (≥50%) asymptomatic carotid stenosis were compared with those from patients with symptomatic carotid stenosis in the early (≤4 weeks) and late phases (≥3 months) after TIA or stroke in this prospective, pilot observational study. Thrombin generation profile was longitudinally assessed in symptomatic patients with data at each time point. Bilateral transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed whenever possible to classify patients as MES-positive or MES-negative. Results Data from 31 asymptomatic, 46 ‘early symptomatic’ and 35 ‘late symptomatic’ patients were analysed. Peak thrombin (344.2 nM vs 305.3 nM; p=0.01) and endogenous thrombin potential (1772.4 vs 1589.7; p=0.047) were higher in early symptomatic than asymptomatic patients. Peak thrombin production decreased in symptomatic patients followed up from the early to late phase after TIA or stroke (339.7 nM vs 308.6 nM; p=0.02). Transcranial Doppler ultrasound data were available in 25 asymptomatic, 31 early symptomatic and 27 late symptomatic patients. Early symptomatic MES-positive patients had a shorter ‘time-to-peak thrombin’ than asymptomatic MES-positive patients (p=0.04), suggesting a more procoagulant state in this early symptomatic subgroup. Discussion Thrombin generation potential is greater in patients with recently symptomatic than asymptomatic carotid stenosis, and decreases over time following TIA or stroke associated with carotid stenosis. These data improve our understanding of the haemostatic/thrombotic biomarker profile in moderate-severe carotid stenosis.