This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vainas, T. Articles by Kitslaar, P. J.E.H.M. Search for Related Content PubMed PubMed Citation Articles by Vainas, T. Articles by Kitslaar, P. J.E.H.M. Related Collections Pathophysiology Carotid Stenosis Doppler ultrasound, Transcranial Doppler etc. Carotid endarterectomy Other Research

(Stroke. 2002;33:1249.)
© 2002 American Heart Association, Inc.

Original Contributions

Chlamydia pneumoniae Serology Is Associated With Thrombosis-Related but Not With Plaque-Related Microembolization During Carotid Endarterectomy

Tryfon Vainas, MD; Harrie A.J.M. Kurvers, MD, PhD; Werner H. Mess, MD; Rick de Graaf, MSc; Rajaa Ezzahiri, MD; Jan H.M. Tordoir, MD, PhD; Geert-Willem H. Schurink, MD, PhD; Cathrien A. Bruggeman, PhD Peter J.E.H.M. Kitslaar, MD, PhD

From the Departments of Surgery (T.V., H.A.J.M.K., R. de G., R.E., J.H.M.T., G-W.H.S., P.J.E.H.M.K.), Clinical Neurophysiology (W.H.M.), and Medical Microbiology (C.A.B.), Maastricht University Hospital and Cardiovascular Research Institute of Maastricht, Maastricht, Netherlands.

Correspondence to Tryfon Vainas, MD, Department of Surgery, Maastricht University Hospital, PO Box 5800, 6202 AZ Maastricht, Netherlands. E-mail t.vainas{at}ah.unimaas.nl

Background and Purpose— Chlamydia pneumoniae has repeatedly been associated with atherosclerotic disease. Our study was designed to clarify whether this association is based on C pneumoniae-induced transformation of a stable into an unstable atherosclerotic plaque or on stimulation of hypercoagulability leading to increased thrombotic arterial occlusions by C pneumoniae infection. Transcranial Doppler ultrasonographic monitoring of the middle cerebral artery during carotid endarterectomy offers the opportunity to study, before removal of the plaque, atherothrombotic emboli dislodging from an unstable carotid plaque (plaque-related emboli) and emboli related to (excessive) thrombus formation at the endarterectomy site after removal of the plaque and restoration of flow (thrombosis-related emboli).

Methods— C pneumoniae IgA (1/16) and IgG (1/64) seropositivity was assessed in 53 patients with symptomatic carotid artery disease undergoing carotid endarterectomy. The removed carotid plaques were studied histologically to assess plaque instability.

Results— Plaque- and thrombosis-related emboli were registered in 43 patients with an adequate transtemporal window. IgA seropositivity (58%) was associated significantly with thrombosis-related embolization (P=0.030) but not with plaque-related embolization or with histological plaque instability.

Conclusions— C pneumoniae serology is associated with microembolization after endarterectomy and restoration of flow. Since these microemboli represent platelet aggregations and are related to cerebrovascular complications, our data suggest that C pneumoniae infection contributes to cerebrovascular events in patients with carotid artery disease through stimulation of thrombosis.

Key Words: carotid artery diseases • infection • intracranial embolism and thrombosis • thrombosis

This article has been cited by other articles:

				P. J. Lindsberg and A. J. Grau Inflammation and Infections as Risk Factors for Ischemic Stroke Stroke, October 1, 2003; 34(10): 2518 - 2532. [Abstract] [Full Text] [PDF]

				H. Kalvegren, M. Majeed, and T. Bengtsson Chlamydia pneumoniae Binds to Platelets and Triggers P-Selectin Expression and Aggregation: A Causal Role in Cardiovascular Disease? Arterioscler Thromb Vasc Biol, September 1, 2003; 23(9): 1677 - 1683. [Abstract] [Full Text] [PDF]