Early recognition of vulnerable patients is an important issue for stroke prevention. In our study, a multiscore analysis of various biomarkers was performed to evaluate its superiority over the analysis of single factors. Study subjects ( ) were divided into four groups: asymptomatic patients with stable ( ) and unstable ( ) plaques and symptomatic patients with stable ( ) and unstable ( ) plaques. Serum levels of MMP-1, -2, -3, -7, -8, -9, TIMP-1, -2, TNF-α, IL-1b, and IL-6, -8, -10, -12 were measured. Multi-score analysis was performed using multiple receiver operating characteristics (ROC) and determination of appropriate cutoff values. Significant differences between the groups were observed for MMP-1, -7, -9 and TIMP-1 in serum of the study subjects ( ). Multiple biomarker analysis led to a significant increase in the AUC (area under curve). In case of plaque instability, positive predictive value (PPV) for up to 86.4% could be correctly associated with vulnerable plaques. Thus, multiscore analysis might be preferable than the use of single biomarkers. 1. Introduction Early recognition of rupture-prone atherosclerotic lesions in patients with high-graded carotid artery stenosis is an important clinical issue to prevent ischemic stroke [1–5]. Various pathophysiological mechanisms are responsible for the plaque progression and vulnerability such as degradation of extracellular matrix components especially by matrix metalloproteinases (MMPs), intensified inflammatory reaction, and neovascularisation [3, 5–7]. These features are the main reason for plaque rupture and consequent neurological symptoms. Thus, MMPs and inflammatory factors might also serve as possible markers for patients with unstable high-graded carotid artery stenosis [2, 8–16]. However, the data that have been achieved up to date are not consistent. Some studies investigated patients with symptomatic versus asymptomatic carotid stenosis or patients with or without emboli [12, 14–17]. Other researchers compared stable versus unstable plaques [2, 18, 19]. Furthermore, only very few investigations evaluated the usefulness of multiple biomarkers to predict rupture-prone atherosclerotic lesions [2, 17, 20, 21]. The aim of this work was the comparison of results of multiple analyses of various relevant biomarkers in patients with stable versus unstable carotid plaques and in individuals with or without neurological symptoms to evaluate whether multiple-score evaluation is superior to the analysis of single factors. 2. Materials and Methods 2.1. Study Patients The retrospective study
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