Title:High-Sensitivity C-Reactive Protein and Lipoprotein-Associated Phospholipase A2 in Predicting Recurrence and Severity of Stenosis in Symptomatic Intracranial Atherosclerotic Disease
VOLUME: 18 ISSUE: 2
Author(s):Soumya Krishnamoorthy , Deepa Damayanthi, Srinivas Gopala, Rejith Paul and P.N. Sylaja*
Affiliation:Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, Department of Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
Keywords:Biomarker, intracranial atherosclerosis, high sensitivity C-reactive protein, lipoprotein-associated phospholipase
A2, stroke recurrence, plaque.
Abstract:Background: Symptomatic intracranial atherosclerotic disease (sICAD) is associated
with the risk of recurrence of cerebral ischemic events in 4-19% of stroke patients annually. Previous
studies indicate elevated high-sensitivity c-reactive Protein (hs-CRP) and lipoprotein-associated
phospholipase A2 (Lp-PLA2) to be associated with risk of recurrence.
Objective: This prospective, observational study investigated serum levels of hs-CRP and the activity
of Lp-PLA2 in patients with sICAD in predicting the risk of long-term stroke recurrence.
Methods: We enrolled 48 patients with sICAD at 3 months from onset. The demographics, clinical,
and imaging characteristics were recorded. Serum hs-CRP and Lp-PLA2 activity were assessed
using automated high-sensitivity C-reactive protein assay and photometric technique, respectively.
Patients were followed up at 6 months and 1 year and the presence of new vascular events
was recorded. Results: The mean age of our study population was 59.5 ± 10.3 years and 91.7%
were men. Four patients developed recurrent strokes during follow-up. The mean Hs-CRP was elevated
in patients with events than in patients without events (5.9 ± 10.4 mg/L vs. 1.7 ± 2.4 mg/L,
P=0.03). However, there was no significant association of mean Lp-PLA2 activity (118.3±42.9
nmol/min/ml vs. 111.9 ± 34.2 nmol/min/ml, P=0.73) with recurrence. Elevation of hs-CRP (3.02 ±
4.8 mg/L vs. 0.95 ± 0.57mg/L, P=0.02) and Lp-PLA2 activity (120.1±40.3 nmol/min/ml vs. 103.3
± 23.9 nmol/min/ml, P=0.04) was correlated with high-grade stenosis in these patients.
Conclusion: Our study suggests serum levels of hs-CRP may serve as a predictor of long-term
stroke recurrence risk in sICAD and elevation of hs-CRP and Lp-PLA2 correlated with the severity
of stenosis in symptomatic intracranial atherosclerotic disease.
