Early complement activation follows eversion carotid endarterectomy and correlates with the time of clamping of the carotid artery

Background: Complement activation plays an important role in ischemia/reperfusion (I/R) injury. The objective of the present study was to detect the presence and mechanism of complement activation in patients who underwent carotid endarterectomy (CEA). Methods: Complement activation products C1rsC1-inhibitor, C4d, C3a and SC5b-9 and concentrations of C-reactive protein (CRP) were measured in samples serially taken from 16 patients with eversion CEA and 10 with carotid artery stenting (CAS) in the first 24h post-surgery/intervention. MBL2 genotypes were also determined. Results: In patients with CEA an intense increase in C3a levels were observed immediately after surgery (p < 0.001), accompanied by a slight elevation in SC5b-9 levels (p < 0.05). C3a levels remained elevated until 4 h post-surgery, compared with the baseline values and with CAS patients. Peak C3a levels correlated with the time of carotid clamping (r = 0.5921, p = 0.02). No significant changes were detected in C1rsC1-inhibitor or C4d levels following CEA, and we found no association between the generation of C3a and MBL2 genotypes or CRP levels. Complement activation was not present in patients with CAS. Conclusions: Early complement activation follows CEA and correlates with the time of I/R injury. The lack of C4d generation suggests the role of the alternative and not the lectin pathway in the process. (C) 2008 Elsevier Ltd. All rights reserved.