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@ARTICLE{Jansen:285464,
      author       = {Jansen, Robin and Wagenhäuser, Markus U and Kölsche,
                      Tristan and Papasimos, Cleopatra and Benkert, Pascal and
                      Kuhle, Jens and Pawlitzki, Marc and Masanneck, Lars and
                      Schreiber, Stefanie and Caspers, Julian and Ruck, Tobias and
                      Hagler, Ramona and Stassen, Malin and Weiss, Daniel and
                      Arndt, Philipp and Dörner, Marc and Mulorz, Joscha and
                      Meuth, Sven G and Schelzig, Hubert and Lee, John-Ih and
                      Gliem, Michael},
      title        = {{S}erum levels of neurofilament light chain ({N}f{L}) and
                      glial fibrillary acid protein ({GFAP}) in patients with
                      asymptomatic and symptomatic carotid artery stenosis.},
      journal      = {JVS-vascular science},
      volume       = {7},
      issn         = {2666-3503},
      address      = {[Amsterdam]},
      publisher    = {Elsevier},
      reportid     = {DZNE-2026-00242},
      pages        = {100408},
      year         = {2026},
      abstract     = {The 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.},
      keywords     = {Asymptomatic carotid artery stenosis (Other) / Risk
                      stratification (Other) / Serum biomarker (Other) / Serum
                      glial fibrillary acid protein (Other) / Serum neurofilament
                      light chain (Other) / Stroke (Other) / Ultrasound (Other)},
      cin          = {AG Schreiber},
      ddc          = {610},
      cid          = {I:(DE-2719)1310010},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41783480},
      pmc          = {pmc:PMC12954281},
      doi          = {10.1016/j.jvssci.2026.100408},
      url          = {https://pub.dzne.de/record/285464},
}