Maintaining Carotid Flow by Shunting During Carotid Endarterectomy Diminishes the Inflammatory Response Mediating Ischaemic Brain Injury

Pärsson, Håkan; Lord, Reginald S. A.; Scott, Kieran F.; Zemack, Göran

doi:10.1053/ejvs.1999.0954

Cited by 21 publications

(25 citation statements)

References 26 publications

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“…Given the subtle nature of the injuries after uncomplicated CEA and the relatively early time of peak serum S100B levels after mild cerebral injuries, it is likely that even earlier S100B sampling (e.g., 2−8 h after CEA) might demonstrate an even stronger correlation between S100B levels and declines in NPMT performance. Also, a recent study of CEA patients reported increased levels of serum markers of inflammation from the jugular bulb ipsilateral to carotid artery clamping (22). We anticipate better correlation between NPMT performance and S100B levels with this more sensitive sampling technique.…”

Section: Discussionmentioning

confidence: 77%

Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

Connolly¹,

Winfree²,

Rampersad³

et al. 2001

Neurosurgery

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OBJECTIVE-Carotid endarterectomy (CEA) is an effective means of stroke prevention among appropriately selected patients; however, neuropsychometric testing has revealed subtle cognitive injuries in the early postoperative period. The purpose of this study was to establish whether serum levels of two biochemical markers of cerebral injury were correlated with postoperative declines in neuropsychometric test performance after CEA. METHODS-Fifty-five consecutive patients underwent a battery of neuropsychometric tests 24hours before and 24 hours after elective CEA. Two patients were excluded because of postoperative strokes. The pre-and postoperative serum levels of S100B protein and neuronspecific enolase for injured patients, defined as those who exhibited significant declines in neuropsychometric test performance (n = 12), were compared with the levels for uninjured patients (n = 41).RESULTS-There were no significant differences in the baseline S100B levels for the two groups. Injured patients exhibited significantly higher S100B levels, compared with uninjured patients, at 24, 48, and 72 hours after surgery (P < 0.05). There were no significant differences in neuron-specific enolase levels for injured and uninjured patients at any time point.CONCLUSION-These data suggest that subtle cerebral injuries after CEA, even in the absence of overt strokes, are associated with significant increases in serum S100B but not neuron-specific enolase levels. Analyses of earlier time points in future studies of subtle cognitive injuries and biochemical markers of cerebral injury after CEA may be revealing. KeywordsCarotid endarterectomy; Cerebral ischemia; Neuron-specific enolase; Neuropsychological tests; S100B Carotid endarterectomy (CEA) is an effective means to prevent stroke among patients at high risk. Although the risk of major stroke after CEA is relatively low, the incidence of subtle cognitive injuries, as revealed by neuropsychometric tests (NPMTs), is quite high (4,6,11). NPMTs are sensitive measures of subtle neurological dysfunctions that are not revealed in routine neurological examinations. We recently demonstrated that as many as A variety of biochemical markers of severe neurological injury have been described. Neuron-specific enolase (NSE) is a glycolytic enzyme found in neurons and neuroendocrine cells (19). The calcium-binding protein S100B is an important participant in neuronal and glial cell-cell communication and intracellular signal transduction and exhibits its highest levels of expression in the nervous system (33). These molecules have been demonstrated to be markers of cerebral injury in animal models of stroke (1,9) and among human stroke patients (3,5,21,23,27).Among patients with cerebral infarctions, high S100B levels were correlated with mildly poorer performance on NPMTs, but these results did not reach significance (32). Another study demonstrated no correlation between increased NSE and S100B levels and a decline in performance on NPMTs after CEA (25). In that study, however, the au...

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Section: Discussionmentioning

confidence: 77%

Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

Connolly¹,

Winfree²,

Rampersad³

et al. 2001

Neurosurgery

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“…PGE 2 is known to directly decrease NK cytotoxicity in vitro (Gatti et al, 1986a; Yakar et al, 2003), through its membrane prostanoid receptors and subsequent elevated intracellular cAMP and activated protein kinase A1 (PKA1) levels (Torgersen et al, 1997a). However, since PGE 2 is released in vivo locally (around the damaged tissue), and its systemic endogenous levels are often not affected (Parsson et al, 2000), it is not clear whether the in vivo effects of PGE 2 depend on a mediating mechanism, such as CORT, which, in the context of surgery, is elevated by PGs (Asoh et al, 1987; Shaashua et al, In press) and by a host of other pro-inflammatory factors (DeKeyser et al, 2000; Turnbull et al, 1994). As will be elaborated below, increased systemic levels of PGs, induced herein by its administration, directly suppressed NKCC in vivo .…”

Section: Discussionmentioning

confidence: 99%

“…For example, we previously reported that systemic administration of PGE 2 that doubled plasma levels of this factor also suppressed in vivo levels of NK cytotoxicity (Yakar et al, 2003). However, it is critical to note that only some studies reported elevated systemic PGE 2 levels after surgery, while other studies reported no such systemic increase (Baxevanis et al, 1994; Buvanendran et al, 2006; Parsson et al, 2000; Vitoratos et al, 1996; Yakar et al, 2003), questioning a direct effect of PGs on NK cytotoxicity. Additionally, although COX inhibitors were shown to reduce post surgical immune suppression (Benish et al, 2008; Faist et al, 1990; Melamed et al, 2005; Yakar et al, 2003), such treatments are also known to reduce CORT levels (Glasner et al, 2010; Shaashua et al, In press).…”

Section: Introductionmentioning

confidence: 99%

PGE2 suppresses NK activity in vivo directly and through adrenal hormones: Effects that cannot be reflected by ex vivo assessment of NK cytotoxicity

Meron

Tishler

Shaashua

et al. 2013

Brain, Behavior, and Immunity

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Surgery can suppress in vivo levels of NK cell cytotoxicity (NKCC) through various mechanisms, including catecholamine-, glucocorticoid (CORT)-, and prostaglandin (PG)-mediated responses. However, PGs are synthesized locally following tissue damage, driving proinflammatory and CORT responses, while their systemic levels are often unaffected. Thus, we herein studied the role of adrenal factors in mediating in vivo effects of PGs on NKCC, using adrenalectomized and sham-operated F344 rats subjected to surgery or PGE2 administration. In vivo and ex-vivo approaches were employed, based on intravenous administration of the NK-sensitive MADB106 tumor line, and based on ex-vivo assessment of YAC-1 and MADB106 target-line lysis. Additionally, in vitro studies assessed the kinetics of the impact of epinephrine, CORT, and PGE2 on NKCC. The results indicated that suppression of NKCC by epinephrine and PGE2 are short lasting, and cannot be evident when these compounds are removed from the in vitro assay milieu, or in the context of ex-vivo assessment of NKCC. In contrast, the effects of CORT are long-lasting and are reflected in both conditions even after its removal. Marginating-pulmonary NKCC was less susceptible to suppression than circulating NKCC, when tested against the xenogeneic YAC-1 target line, but not against the syngeneic MADB106 line, which seems to involve different cytotoxicity mechanisms. Overall, these findings indicate that elevated systemic PG levels can directly suppress NKCC in vivo, but following laparotomy adrenal hormones mediate most of the effects of endogenously-released PGs. Additionally, the ex-vivo approach seems limited in reflecting the short-lasting NK-suppressive effects of catecholamines and PGs.

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“…We attempted to reduce risks of cerebral ischemia by using shunt intraoperatively. 28,29 And mean postoperative neurological complications incidence of patients treated by us declined as time went on ( Figure 6). However, F I G U R E 5 Patients whose nerves were injured or disturbed in operations still suffered neurological complications at follow-up in two groups [Color figure can be viewed at wileyonlinelibrary.com] nerve injuries were hard to be avoided completely in operations, especially for large CBTs.…”

Section: Discussionmentioning

confidence: 98%

Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study

Zhao

et al. 2019

Head & Neck

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Backgrounds Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine‐producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before. Methods Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods. Results Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups. Conclusions A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short‐term surgical complications.

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Maintaining Carotid Flow by Shunting During Carotid Endarterectomy Diminishes the Inflammatory Response Mediating Ischaemic Brain Injury

Abstract: there is a metabolic response to carotid cross-clamping when no shunt is used. However, the clinical significance of this is unclear, since there were no intraoperative strokes.

Cited by 21 publications

References 26 publications

Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

PGE2 suppresses NK activity in vivo directly and through adrenal hormones: Effects that cannot be reflected by ex vivo assessment of NK cytotoxicity

Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study

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