Platelet activation, function, and reactivity in atherosclerotic carotid artery stenosis: a systematic review of the literature

Authors

  • J. A. Kinsella,

    1. Department of Neurology, The Adelaide and Meath Hospital, Dublin
    2. National Children's Hospital (AMNCH), Trinity College Dublin, Dublin, Ireland
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  • W. O. Tobin,

    1. Department of Neurology, The Adelaide and Meath Hospital, Dublin
    2. National Children's Hospital (AMNCH), Trinity College Dublin, Dublin, Ireland
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  • G. Hamilton,

    1. Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
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  • D. J. H. McCabe

    Corresponding author
    1. National Children's Hospital (AMNCH), Trinity College Dublin, Dublin, Ireland
    2. Department of Stroke Service, The Adelaide and Meath Hospital, Dublin
    3. Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK
    • Department of Neurology, The Adelaide and Meath Hospital, Dublin
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  • Conflict of interest: None of the authors reports any conflicts of interest or other disclosures. None of the charities or funding bodies had any influence on design or conduct of this systematic review or had any influence on the decision to submit the final manuscript for publication.
  • Funding: Dr Kinsella's research was funded by the Stanley Thomas Johnson Foundation and by unrestricted educational grant funding from Bayer Schering Ireland, Pfizer Ireland, and Elitech UK. Dr Tobin's research was funded by the IICN-Serono Fellowship, Meath Foundation, Lundbeck Neurosciences Bursary programme and by unrestricted educational grant funding from Merck Serono Ireland, Brennan and Company, Ireland, and Biogen Idec Ireland Limited. Dr McCabe's research programme was part funded by grant support from the Programme for Research in Third Level Institutions in Ireland (Cycle 4), cofunded by the European Regional Development Fund.

Correspondence: Dominick J. H. McCabe, Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.

E-mail: dominick.mccabe@amnch.ie

Abstract

An important proportion of transient ischemic attack or ischemic stroke is attributable to moderate or severe (50–99%) atherosclerotic carotid stenosis or occlusion. Platelet biomarkers have the potential to improve our understanding of the pathogenesis of vascular events in this patient population. A detailed systematic review was performed to collate all available data on ex vivo platelet activation and platelet function/reactivity in patients with carotid stenosis. Two hundred thirteen potentially relevant articles were initially identified; 26 manuscripts met criteria for inclusion in this systematic review. There was no consistent evidence of clinically informative data from urinary or soluble blood markers of platelet activation in patients with symptomatic moderate or severe carotid stenosis who might be considered suitable for carotid intervention. Data from flow cytometry studies revealed evidence of excessive platelet activation in patients in the early, sub-acute, or late phases after transient ischemic attack or stroke in association with moderate or severe carotid stenosis and in asymptomatic moderate or severe carotid stenosis compared with controls. Furthermore, pilot data suggest that platelet activation may be increased in recently symptomatic than in asymptomatic severe carotid stenosis. Excessive platelet activation and platelet hyperreactivity may play a role in the pathogenesis of first or subsequent transient ischemic attack or stroke in patients with moderate or severe carotid stenosis. Larger longitudinal studies assessing platelet activation status with flow cytometry and platelet function/reactivity in symptomatic vs. asymptomatic carotid stenosis are warranted to improve our understanding of the mechanisms responsible for transient ischemic attack or stroke.

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