Metabolomic determinants of carotid atherosclerosis plaque stability

Our objective is to identify the metabolites associated with stability of carotid atheromatous plaques compared to vulnerable plaques, through a metabolomic approach. Eighty consecutive patients with carotid artery stenosis (CAS) who underwent carotid endarterectomy (CEA) according to current guidelines with metabolomic analysis of the removed plaque were included between may 2021 and august 2022, in the vascular surgery department of Marseille University Hospital. Symptomatic patients were qualified by stroke physicians if they experienced an ischemic stroke (IS) or transient ischemic attack (TIA) in the territory of the culprit artery less than a month before the surgery, with an otherwise negative exhaustive etiological assessment. Patients who did not report any medical history of IS/TIA in the last 6 months before surgery were considered asymptomatic. Patients with history of IS/TIA between one and six months before surgery were excluded (n=8). The metabolomes of 72 remaining carotid atherosclerotic plaques were compared according to their symptomatic status. The Institutional Review Board of Assistance Publique-Hôpitaux de Marseille approved this study (No. CSE24-4).