Increased Leucocyte–Platelet Complex Formation in Recently Symptomatic versus Asymptomatic Carotid Stenosis Patients and in Micro-emboli Negative Subgroups

Stephen J. X. Murphy; Soon Tjin Lim; Justin A. Kinsella; Sean Tierney; Bridget Egan; T. M. Feeley; Sinead M. Murphy; Richard A. Walsh; D. R. Collins; Tara Coughlan; Desmond O'Neill; Joseph A. Harbison; Prakash Madhavan; Sean M. O'Neill; Mary P. Colgan; Dermot Cox; Niamh Moran; George Hamilton; Dominick J. H. McCabe

doi:10.1055/s-0039-1678666

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(05): 821-833
DOI: 10.1055/s-0039-1678666

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Increased Leucocyte–Platelet Complex Formation in Recently Symptomatic versus Asymptomatic Carotid Stenosis Patients and in Micro-emboli Negative Subgroups

Stephen J. X. Murphy

¹Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Soon Tjin Lim

¹Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Justin A. Kinsella

³Department of Neurology, St Vincent’s University Hospital, University College Dublin, Dublin, Ireland

,

Sean Tierney

⁴Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Bridget Egan

⁴Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

T. M. Feeley

⁴Department of Vascular Surgery, Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁵Dublin Midlands Hospital Group, Ireland

,

Sinead M. Murphy

¹Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁶Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁷Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland

,

Richard A. Walsh

¹Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁷Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Ireland

,

D. R. Collins

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁶Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Tara Coughlan

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁶Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Desmond O'Neill

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁶Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

,

Joseph A. Harbison

⁸Department of Medicine for the Elderly/Stroke Service, St James Hospital/Trinity College Dublin, Ireland

,

Prakash Madhavan

⁹Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland

,

Sean M. O'Neill

⁹Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland

,

Mary P. Colgan

⁹Department of Vascular Surgery, St James Hospital/Trinity College Dublin, Dublin, Ireland

,

Dermot Cox

¹⁰Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland

,

Niamh Moran

¹⁰Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland

,

George Hamilton

¹¹Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, United Kingdom

,

Dominick J. H. McCabe

¹Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

²Stroke Service, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

⁶Age-Related Health Care Department, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

¹²Vascular Neurology Research Foundation, c/o Department of Neurology, Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH)/Tallaght University Hospital, Dublin, Ireland

¹³Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, United Kingdom

¹⁴Irish Centre for Vascular Biology, Dublin, Ireland

› Author Affiliations

Abstract

Introduction Cerebral micro-embolic signals (MES) predict risk of stroke in carotid stenosis patients. However, MES-negative ‘recently symptomatic patients’ also have a higher stroke risk than ‘asymptomatic patients’. Differences in platelet activation status may contribute to this disparity in risk.

Methods This prospective, observational study assessed platelet biomarkers and their relationship with MES in asymptomatic versus symptomatic moderate (≥50–69%) or severe (≥70–99%) carotid stenosis patients. Full blood count parameters were measured and whole-blood flow cytometry was used to quantify platelet surface CD62P and CD63 expression and leucocyte–platelet complex formation. Bilateral simultaneous transcranial Doppler ultrasound of the middle cerebral arteries classified patients as ‘MES positive’ or ‘MES negative’.

Results Data from 34 asymptomatic patients were compared with those from 43 symptomatic patients in the ‘early phase’ (≤ 4 weeks) and 37 of these symptomatic patients in the ‘late phase’ (≥ 3 months) after transient ischaemic attack/ischaemic stroke. There were no differences in %CD62P or %CD63 expression between early or late symptomatic and asymptomatic patients overall (p > 0.05). The percentage of lymphocyte–platelet complexes was higher in early symptomatic than in asymptomatic patients (2.8 vs. 2.16%; p < 0.001). MES were more commonly observed in early symptomatic (31.4%; p = 0.027) but not in late symptomatic (6.7%; p = 0.996) versus asymptomatic patients (7.1%). The percentage of lymphocyte–platelet complexes was higher in early symptomatic than in asymptomatic MES-negative patients (2.7 vs. 2.17%; p = 0.02).

Conclusion These data add to the evidence that leucocyte–platelet complex formation/platelet activation is increased in recently symptomatic versus asymptomatic patients, and may contribute to the pathogenesis of first and subsequent strokes in carotid stenosis patients, including those who are MES negative.

Keywords

asymptomatic and symptomatic carotid stenosis - platelet activation - flow cytometry - lymphocyte–platelet complexes - transcranial Doppler ultrasound

Full Text

References

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