Fluctuations of serum neuron specific enolase and protein S-100B concentrations in relation to the use of shunt during carotid endarterectomy.

Abstract

OBJECTIVE:

To evaluate the changes in serum neuron specific enolase and protein S-100B, after carotid endarterectomy performed using the conventional technique with routine shunting and patch closure, or eversion technique without the use of shunt.

MATERIALS AND METHODS:

Prospective non-randomized study included 43 patients with severe (>80%) carotid stenosis undergoing carotid endarterectomy in regional anesthesia. Patients were divided into two groups: conventional endarterectomy with routine use of shunt and Dacron patch (csCEA group) and eversion endarterectomy without the use of shunt (eCEA group). Protein S-100B and NSE concentrations were measured from peripheral blood before carotid clamping, after declamping and 24 hours after surgery.

RESULTS:

Neurologic examination and brain CT findings on the first postoperative day did not differ from preoperative controls in any patients. In csCEA group, NSE concentrations decreased after declamping (P<0.01), and 24 hours after surgery (P<0.01), while in the eCEA group NSE values slightly increased (P=ns), accounting for a significant difference between groups on the first postoperative day (P=0.006). In both groups S-100B concentrations significantly increased after declamping (P<0.05), returning to near pre-clamp values 24 hours after surgery (P=ns). Sub-group analysis revealed significant decline of serum NSE concentrations in asymptomatic patients shunted during surgery after declamping (P<0.05) and 24 hours after surgery (P<0.01), while no significant changes were noted in non-shunted patients (P=ns). Decrease of NSE serum levels was also found in symptomatic patients operated with the use of shunt on the first postoperative day (P<0.05). Significant increase in NSE serum levels was recorded in non-shunted symptomatic patients 24 hours after surgery (P<0.05).

CONCLUSION:

Variations of NSE concentrations seemed to be influenced by cerebral perfusion alterations, while protein S-100B values were unaffected by shunting strategy. Routine shunting during surgery for symptomatic carotid stenosis may have the potential to prevent postoperative increase of serum NSE levels, a potential marker of brain injury.

• Authors: Marko Dragas, Igor Koncar, Dragan Opacic, Nikola Ilic, Zivan Maksimovic, Miroslav Markovic, Marko Ercegovac, Tatjana Simic, Marija Pljesa-Ercegovac, Lazar Davidovic
• Journal: PloS one (PLoS One) Vol. 10 Issue 4 Pg. e0124067 ( 2015) ISSN: 1932-6203 [Electronic] United States
• PMID: 25859683 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Polyethylene Terephthalates
• S100 Calcium Binding Protein beta Subunit
• Phosphopyruvate Hydratase

Topics

• Aged
• Carotid Stenosis (blood, surgery)
• Endarterectomy, Carotid (adverse effects, methods)
• Female
• Humans
• Male
• Middle Aged
• Phosphopyruvate Hydratase (blood)
• Polyethylene Terephthalates
• Prospective Studies
• S100 Calcium Binding Protein beta Subunit (blood)
• Vascular Closure Devices