Early non-invasive diagnostic information would be useful in identifying patients at risk of progressive
carotid atherosclerosis, despite an apparently harmless plaque on ultrasound imaging. In this study, we assessed the possible association of intracellular
cytokines in peripheral blood with the ultrasound (
stenosis > or = 70%) and clinical indications (transient ischaemic attack,
amaurosis fugax or
stroke) for
carotid endarterectomy (CEA) in patients. Intracellular
cytokine expression was determined in 106 patients (67 undergoing and 39 not undergoing CEA). Cells primed for the proinflammatory
cytokines tumour
necrosis factor (
TNF)-alpha,
interferon (IFN)-gamma,
interleukin (IL)-1beta,
IL-6,
IL-8 and the anti-inflammatory
cytokines IL-4 and
IL-10 were found in significantly higher percentages in patients undergoing CEA than in patients who were not (P < 0.05). Intracellular
cytokine expression was significantly higher in patients undergoing CEA who had
stenosis > or = 70% (TNF-alpha, IFN-gamma, IL-1beta, IL-6, IL-4 and IL-10), with previous
stroke (IFN-gamma, IL-1beta, IL-6, IL-8, IL-4 and IL-10) and with
amaurosis fugax (IFN-gamma, IL-6, IL-4 and IL-10) than in patients not undergoing CEA. Increased intracellular
cytokines in patients' peripheral blood might be a warning signal indicating progressive
atherosclerosis. If so, intracellular
cytokine monitoring could help in selecting patients at high risk of future clinical cardiovascular events and therefore most likely to benefit from CEA or adjustment of pharmacological
therapy.