Carotid endarterectomy and gliofibrillar S100b protein release

Abstract

Increased levels of the gliofibrillar S100b protein can be detected during carotid endarterectomy (CEA). Whether the S100b protein increase is marker of brain ischemic sufferance and predictor of cognitive decline is controversial. Twenty-eight patients underwent clinical assessment and cranial computed tomography (CT) 24-48 hours before and 3 months after CEA. S100b serum levels were evaluated before surgery, at cross-clamping, 10 minutes later, at declamping, and 24-48 hours and 10-12 weeks after CEA. Increased S100b levels were detected in 11 patients (39%); eight (73%) of these patients had symptomatic carotid artery disease. Increased S100b level correlated with history of TIA or stroke ( p=0.005), low mini-mental state examination score ( p=0.02), and ischemic infarctions at preoperative CT ( p=0.03). Slight and transient increased S100b levels were detected in 39% of patients during CEA. The protein levels increased despite the absence of clinical events during surgery. Our findings suggest a failure of compensatory hemodynamic or metabolic mechanisms in peri-ischemic tissue, whose longterm effects on cognition remain to be investigated.

Correlation between Amitriptyline-Induced Cardiotoxic Effects and Cardiac S100b Protein in Isolated Rat Hearts

“…S100B is primarily expressed by the brain tissue but is also expressed by myocardial cells. Previous clinical and experimental studies showed that serum S100b levels increase in coronary artery bypass grafting, carotid endarterectomy and myocardial ischemia (9,(24)(25)(26). The data about the increase of S100b levels or expressions in isolated heart tissue is limited.…”

Psychological impact of carotid endarterectomy: A review of the studies

“…Results of studies on the cognitive change after CEA were controversial. Among the 21 studies some did not found any cognitive change [31,37,39,42,51,55], others revealed the presence of some not statistically significant changes, [33,35,48]. Other studies found a different course of the cognitive change relative to the different length of time between pre-and post-test [32,35,36,38,[43][44]48].…”

“…Terevnikov and colleagues [32] administered the tests 7-10 days after surgery, at 1 month follow-up and, than every 6 months for 2 years; Bossema and colleagues [33] performed two post-operative assessments at 3 months and one year, and the most recent study of Bo and colleagues [34] used a 3 years post-operative follow-up. In most studies (13/21, 62%) the follow-up period ranged between few days to 6 months [35][36][37][38][39][40][41][42][43][44][45][46][47], while 4 studies measured the cognitive performance immediately after CEA (between 6 hours and 4 days) [48][49][50][51]. It is interesting to notice, as Table 1 points out, that a decline has been found especially in studies that measured the cognitive performance, few days after surgery or within one month from it [37,46,47,49,50], while in studies with a longer follow-up improvement seems to prevail [31,32,40,46], made exception for a recent study [34] that reveals a decline in patient with left symptomatic stenosis.…”

“…Moreover, 3 studies [40,46,47] reported to have used selectively a shunt and one [38] reported to use it routinely. 4 studies [33,36,39,50] considered the possibility of using the right hand or the left; only 3 studies [33,50,51] specified the duration of the operation; 4 studies [35,46,50,51] specified the clamping-time; 5 studies [34,35,39,44,50,51] considered specific clinical characteristics of patients, such as smoking, diabetes, hyperlipidemia, hypertension and hypercholesterolemy; 2 studies [42,49] pointed out the level of S100B; 1 study [46] considered the presence of the APOE-epsilon 4 allele; finally 1 study [47] considered the level of the leucocytes.…”

“…Some studies found improvements only in specific areas, and a stable course or decline in others [32,33,36,41,49]. Other studies found different courses relative to specific characteristics of patients [38,42,49]. For example, Kishikawa and colleagues [38] found worse results in patients with cerebrovascular lesions, while patients with serious stenosis showed improvements.…”