TY - JOUR
T1 - Evaluation of Subclinical Cerebral Injury and Neuropsychologic Function in Patients Undergoing Carotid Endarterectomy
AU - Falkensammer, Juergen
AU - Oldenburg, W. Andrew
AU - Hendrzak, Andrea J.
AU - Neuhauser, Beate
AU - Pedraza, Otto
AU - Ferman, Tanis
AU - Klocker, Joseph
AU - Biebl, Matthias
AU - Hugl, Beate
AU - Meschia, James F.
AU - Hakaim, Albert G.
AU - Brott, Thomas G.
N1 - Funding Information:
The Mayo Foundation supported J. F. A Vascular Surgery Research Grant from the J. William Von Liebig Foundation supported the work of M. B., J. K., B. H., and B. N. at Mayo Clinic Jacksonville.
PY - 2008/7
Y1 - 2008/7
N2 - We examined subclinical alterations of cerebral function during carotid endarterectomy (CEA) and predictability of minor cerebral damage by perioperative levels of biochemical markers of brain damage (S100B and neuron-specific enolase [NSE]). Twenty consecutive patients with ≥70% asymptomatic carotid stenosis undergoing elective CEA were enrolled. Pre- and postoperative testing included magnetic resonance imaging (MRI) of the head, a standardized neurological exam, a battery of neuropsychological tests, and measurement of serum levels of S100B and NSE. There were no major ischemic strokes. In one patient, a mild weakness of the contralateral lower extremity was discovered on neurological examination; in another individual, postoperative MRI revealed two new small subcortical lesions without clinical correlate. While S100B increased significantly early after opening of the carotid clamp (p = 0.015), the NSE increase did not reach statistical significance. As a group, participants obtained a significantly higher mean overall neuropsychological score at follow-up testing (p < 0.05). In one patient, a significant decline of cognitive function was observed. This was the only individual to obtain a consistently high S100B and NSE increase. Neuropsychological testing combined with measurements of S100B and NSE may improve sensitivity when assessing subtle cerebral damage following CEA.
AB - We examined subclinical alterations of cerebral function during carotid endarterectomy (CEA) and predictability of minor cerebral damage by perioperative levels of biochemical markers of brain damage (S100B and neuron-specific enolase [NSE]). Twenty consecutive patients with ≥70% asymptomatic carotid stenosis undergoing elective CEA were enrolled. Pre- and postoperative testing included magnetic resonance imaging (MRI) of the head, a standardized neurological exam, a battery of neuropsychological tests, and measurement of serum levels of S100B and NSE. There were no major ischemic strokes. In one patient, a mild weakness of the contralateral lower extremity was discovered on neurological examination; in another individual, postoperative MRI revealed two new small subcortical lesions without clinical correlate. While S100B increased significantly early after opening of the carotid clamp (p = 0.015), the NSE increase did not reach statistical significance. As a group, participants obtained a significantly higher mean overall neuropsychological score at follow-up testing (p < 0.05). In one patient, a significant decline of cognitive function was observed. This was the only individual to obtain a consistently high S100B and NSE increase. Neuropsychological testing combined with measurements of S100B and NSE may improve sensitivity when assessing subtle cerebral damage following CEA.
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U2 - 10.1016/j.avsg.2008.01.013
DO - 10.1016/j.avsg.2008.01.013
M3 - Article
C2 - 18504102
AN - SCOPUS:46649102831
SN - 0890-5096
VL - 22
SP - 497
EP - 504
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
IS - 4
ER -