{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T15:16:15Z","timestamp":1784042175383,"version":"3.55.0"},"reference-count":55,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T00:00:00Z","timestamp":1695254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Background: We investigated the relationship of matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score with the severity and vulnerability of carotid atherosclerosis and major adverse cardiovascular events (MACE) during follow-up of carotid artery revascularization. Methods: We enrolled 262 patients undergoing carotid revascularization therapy (GRT), 109 asymptomatic patients with low-grade carotid stenosis (40\u201370%) receiving conservative treatment (GCT), and 92 age- and sex-matched control subjects without carotid atherosclerosis (GCO). All participants underwent carotid ultrasound and we assessed at baseline clinical parameters, metabolic profile, CAVI, GSM, and circulating levels of hsCRP, MMP-3,-7,-9, and TIMP-1. Results: Both GRT and GCT presented with elevated CAVI, MMPs, and TIMP-1 levels compared to GCO (p &lt; 0.001). The escalation highly correlated to the presence of symptoms or paralleled the degree of carotid stenosis (p &lt; 0.001). During follow-up (mean duration: 55 months), 51 GRT patients experienced MACE unrelated to the revascularization procedure. Within GRT, diabetes (HR: 2.07; CI: 1.55\u20132.78, p &lt; 0.001), smoking (HR: 1.67; CI: 1.35\u20131.95, p &lt; 0.001), high CAVI (HR: 1.22; CI: 1.09\u20131.43, p = 0.023) and MMP-9 (HR: 1.44; CI: 1.29\u20132.15, p = 0.005), and low GSM (HR: 1.40; CI: 1.16\u20132.12, p = 0.002) independently predicted MACE occurrences, despite the optimum medical therapy. Conclusions: Novel imaging and biochemical biomarkers were positively associated with atherosclerosis severity, while CAVI, MMP-9, and low GSM showed a positive, independent relationship with MACE after carotid revascularization, describing \u201cvulnerable patients\u201d.<\/jats:p>","DOI":"10.3390\/biom13091427","type":"journal-article","created":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T21:08:36Z","timestamp":1695330516000},"page":"1427","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Novel Biomarkers and Imaging Indices for the \u201cVulnerable Patient\u201d with Carotid Stenosis: A Single-Center Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-3488","authenticated-orcid":false,"given":"Nikolaos","family":"Kadoglou","sequence":"first","affiliation":[{"name":"Medical School, University of Cyprus, 2029 Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos G.","family":"Moulakakis","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Patras University Hospital, University of Patras, Rio, 265 04 Patra, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Mantas","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8867-3661","authenticated-orcid":false,"given":"Aris","family":"Spathis","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, National and Kapodistrian University of Athens, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Gkougkoudi","sequence":"additional","affiliation":[{"name":"Medical School, University of Cyprus, 2029 Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9875-4614","authenticated-orcid":false,"given":"Spyridon N.","family":"Mylonas","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, University Hospital of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Kakisis","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 115 27 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Liapis","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 115 27 Athens, Greece"},{"name":"Department of Vascular and Endovascular Surgery, Athens Medical Center, 106 73 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1161\/CIR.0b013e3182456d46","article-title":"Executive summary: Heart disease and stroke statistics--2012 update: A report from the American Heart Association","volume":"125","author":"Roger","year":"2012","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.5551\/jat.RV17044","article-title":"Usefulness of Carotid Ultrasonography for Risk Stratification of Cerebral and Cardiovascular Disease","volume":"27","author":"Nezu","year":"2020","journal-title":"J. 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