Subtle Cerebral Damage after Shunting vs Non Shunting during Carotid Endarterectomy

Abstract

There was no difference in subtle cerebral damage between patients randomized to receive a shunt or not.

Comparative study on carotid revascularization (endarterectomy vs stenting) using markers of cellular brain injury, neuropsychometric tests, and diffusion-weighted magnetic resonance imaging

“…S100␤ and NSE proteins are considered markers of cerebral injuries. 5,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Because of the S100␤ short half-life of about 2 hours, the sustained elevated levels observed in the serum of stroke patients likely represent ongoing release of the marker by perishing tissue as the densely ischemic infarction core expands and recruits marginally viable penumbral tissues into the enlarging necrotic region so that sustained S100␤ release occurs with the death of the penumbral tissues. 39 As a consequence, peak S100␤ serum levels can be sustained for long periods and can be demonstrated on days 2 to 4 after middle cerebral artery infarctions.…”

“…3 Recent studies have focused on the role of microembolization after revascularization as causing neurocognitive decline that can be detected by the use of neuropsychometric tests. [4][5][6][7][8] Subclinical neurologic ischemic events can also be detected by measuring serum markers of brain injury. A variety of biochemical markers of brain injury have been described.…”

Routine or Selective Carotid Artery Shunting for Carotid Endarterectomy and Different Methods of Monitoring in Selective Shunting

“…4 -7 Three (686 patients) compared routine shunting with no shunting. 4 -6 Allocation was adequately concealed in one trial, 5 unclear in one, 6 and quasirandomized in the other. 4 There were crossovers between treatment arms in 2 of the trials, 4,5 but neither trial excluded patients after randomization, and analysis was by intention to treat.…”

“…4 There were crossovers between treatment arms in 2 of the trials, 4,5 but neither trial excluded patients after randomization, and analysis was by intention to treat. The treatment groups were comparable in 2 trials, 4,6 but no baseline data were available in the other trial. 5 There were no losses to follow-up in any trial, but the duration was only 30 days.…”

Serum Neuron-Specific Enolase as a Marker of Brain Ischemia-Reperfusion Injury in Patients Undergoing Carotid Endarterectomy

“…Th ere was no diff erence in subtle cerebral damage between patients randomized to receive a shunt or not 13 . Gao et al…”