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000285464 1001_ $$aJansen, Robin$$b0
000285464 245__ $$aSerum levels of neurofilament light chain (NfL) and glial fibrillary acid protein (GFAP) in patients with asymptomatic and symptomatic carotid artery stenosis.
000285464 260__ $$a[Amsterdam]$$bElsevier$$c2026
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000285464 520__ $$aThe treatment of carotid artery stenosis (CAS) for stroke prevention is a matter of debate due to conflicting data, missing recent data, and advances in medical treatment options but also in interventional techniques and surgery. Therefore, the establishment of an easily available marker for brain damage might be a key tool in this patient group to guide treatment.A retrospective cross-sectional study was conducted leveraging a vascular surgery biobank of 95 patients aged 60 to 80 years. Serum neurofilament light chain (sNfL) and serum glial fibrillary acid protein (sGFAP) were evaluated using highly sensitive electrochemiluminescence immunoassays and z-scores. Discriminatory performance was assessed to differentiate between 19 symptomatic and 76 asymptomatic patients with CAS and their correlation with the degree of stenosis according to ultrasound-based North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria.SNfL levels were markedly elevated in symptomatic compared with asymptomatic patients (median 17.4 vs 3.8 pg/mL; P < .001). sNfL robustly discriminated between these patients (area under the curve = 0.83; 95% confidence interval, 0.72-0.94), as did the NfL z-score (area under the curve = 0.83; 95% confidence interval, 0.71-0.95). Interestingly, within the asymptomatic cohort, sNfL levels demonstrated a significant, positive correlation with the degree of stenosis (Spearman's ρ = 0.24; P = .036). Serum levels of SGFAP were also associated with symptomatic status, albeit with a P-value >.05 (0.1 vs 0.1 pg/mL; (P = .057).The study provides evidence of increased sNfL in symptomatic vs asymptomatic CAS and, of note, of ongoing neuronal or glial damage in some patients with clinically asymptomatic CAS, with a positive correlation between sNfL and the degree of CAS. sNfL is a promising and already accessible blood biomarker that may guide therapeutic decisions in this patient population. The role of sGFAP remains elusive and must be evaluated in larger studies.The CREST-2 trial has recently highlighted the high efficacy of intensive medical management in asymptomatic carotid artery stenosis (CAS), making the selection of patients for revascularization increasingly complex. Our study addresses this challenge by evaluating serum neurofilament light chain (sNfL) and serum glial fibrillary acid protein (sGFAP) as an objective biomarker for neuronal injury. Using individualized z-scores, we demonstrate that sNfL effectively differentiates symptomatic status (area under the curve = 0.828) and significantly correlates with the degree of stenosis in asymptomatic cohorts. These results suggest that sNfL can detect subclinical 'silent' damage, providing a valuable biological tool to pinpoint high-risk patients who may require intervention beyond medical therapy alone. This represents a significant step toward personalized stroke prevention and refined risk stratification in the highly debated field of CAS management.
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000285464 650_7 $$2Other$$aAsymptomatic carotid artery stenosis
000285464 650_7 $$2Other$$aRisk stratification
000285464 650_7 $$2Other$$aSerum biomarker
000285464 650_7 $$2Other$$aSerum glial fibrillary acid protein
000285464 650_7 $$2Other$$aSerum neurofilament light chain
000285464 650_7 $$2Other$$aStroke
000285464 650_7 $$2Other$$aUltrasound
000285464 7001_ $$aWagenhäuser, Markus U$$b1
000285464 7001_ $$aKölsche, Tristan$$b2
000285464 7001_ $$aPapasimos, Cleopatra$$b3
000285464 7001_ $$aBenkert, Pascal$$b4
000285464 7001_ $$aKuhle, Jens$$b5
000285464 7001_ $$aPawlitzki, Marc$$b6
000285464 7001_ $$aMasanneck, Lars$$b7
000285464 7001_ $$0P:(DE-2719)2812631$$aSchreiber, Stefanie$$b8$$udzne
000285464 7001_ $$aCaspers, Julian$$b9
000285464 7001_ $$aRuck, Tobias$$b10
000285464 7001_ $$aHagler, Ramona$$b11
000285464 7001_ $$aStassen, Malin$$b12
000285464 7001_ $$aWeiss, Daniel$$b13
000285464 7001_ $$0P:(DE-2719)9000797$$aArndt, Philipp$$b14$$udzne
000285464 7001_ $$0P:(DE-2719)9002951$$aDörner, Marc$$b15$$udzne
000285464 7001_ $$aMulorz, Joscha$$b16
000285464 7001_ $$aMeuth, Sven G$$b17
000285464 7001_ $$aSchelzig, Hubert$$b18
000285464 7001_ $$aLee, John-Ih$$b19
000285464 7001_ $$aGliem, Michael$$b20
000285464 773__ $$0PERI:(DE-600)3061185-4$$a10.1016/j.jvssci.2026.100408$$gVol. 7, p. 100408 -$$p100408$$tJVS-vascular science$$v7$$x2666-3503$$y2026
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