Combined treatment using CEA and CAS for carotid arterial stenosis

Gene expression analysis: Regulation of key genes associated with mycophenolate mofetil treatment of symptomatic carotid artery stenosis

The present study analyzed gene expression arrays to identify differentially-expressed genes (DEGs) between mycophenolate mofetil (MMF)-treated and placebo-treated patients with symptomatic carotid artery stenosis (SCAS). In addition, the key genes involved in the pharmacology of MMF treatment in patients with SCAS were identified. The gene expression dataset was obtained from a Gene Expression Omnibus database, which included 9 MMF-treated and 11 placebo-treated samples. The DEGs were identified between MMF and placebo groups using R software. Furthermore, a protein-protein interaction (PPI) network of the identified DEGS was constructed. The Database for Annotation, Visualization and Integrated Discovery was used to perform Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses of the 19 most significant DEGs. A total of 210 DEGs between the MMF and placebo groups were screened and their PPI was constructed. GO function analysis revealed that the 19 DEGs were predominantly involved in the tyrosine phosphorylation of signal transducer and activator of transcription-5 protein, which is closely associated with the activation of T cells. The KEGG pathway analysis suggested that the main metabolic pathways of the 19 DEGs were associated with the pharmacological functioning of MMF in activated T cells. In conclusion, the present study identified numerous key DEGs associated with SCAS, and the results suggested that v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog and apelin may serve important roles in the MMF treatment of SCAS.

Surgical Treatment of Carotid Artery Stenosis

BACKGROUND AND PURPOSE

The indications for carotid endarterectomy (CEA) and carotid artery stenting (CAS) have not been established. CEA is more appropriate than CAS if soft atherosclerotic plaques are included in the stenotic lesion, since such soft plaques are associated with a high incidence of ischemic complications during CAS. This report presents our surgical methods and the clinical results of CEA and CAS, and suggests an appropriate treatment strategy using plaque diagnosis, especially for high-risk patients.

MATERIALS AND METHODS

From January 2001 until December 2013 we surgically treated carotid stenosis in 241 lesions by CEA, and 309 lesions by CAS. The average age of the patients was 70.5 in CEA and 71.4 in CAS. The symptomatic stenosis rate was 67 % and the average stenotic rate was 82 % in CEA; these were 61 % and 66 %, respectively, in CAS.

RESULTS

Stenosis of carotid arteries was relieved in all cases after CEA or CAS. Peri-operative mortality with CEA and CAS was 0.4 % (1/241) and 0.3 % (1/309), respectively. Morbidity by ischemic stroke with CEA and CAS was 2.9 % (7/241) and 1.6 % (5/309), respectively. Surgical morbidity was not high in patients with medical risk factors.

CONCLUSIONS

Carotid stenotic lesions can be treated with comparably low morbidity and mortality rates using CEA and/or CAS even with high risks when appropriate surgical methods are selected, considering each characteristic of carotid stenosis using plaque diagnosis.