Assessment of early brain damage in carotid endarterectomy: evaluation of S-100B serum levels and somatosensory evoked potentials in a pilot study.
The release of the neuronal protein S-100B into the circulation has been suggested as an early indication of cellular brain damage. The objective of this prospective pilot study was to determine S-100B serum levels in patients undergoing cross-clamping during carotid endarterectomy (CEA) and to correlate the results with the monitoring of somatosensory evoked potentials (SSEP) and the neurological short-term outcome. Arterial blood samples of 21 patients were drawn before oral intubation, cross-clamping, and unclamping, as well as before extubation and 6 hours later. Recording of SSEP was obtained during carotid occlusion and reperfusion. If loss of SSEP appeared, cerebral ischemia was assumed and an intraluminal shunt was placed. During cross-clamping, S-100B serum levels of 14 patients increased significantly from 0.05 ng/ml to 0.21 ng/ml, but returned to baseline levels after unclamping. In 5 cases, loss of SSEP amplitudes occurred but was reversed by the shunt insertion. No significant differences of S-100B serum values, neurological examination, and carotid duplex surveillance became obvious in this group when compared to the patients with undisturbed SSEP. However, 2 patients with complete disappearance of postcentral SSEP components suffered from neurological deficits in the postoperative period. S-100B serum levels remained highly elevated 6 hours after extubation (0.78 ng/ml and 0.41 ng/ml) compared to the baseline values (0.15 ng/ml and 0.07 ng/ml). During CEA a transitory increase of the S-100B serum levels appears to present an impairment of the blood-brain barrier integrity without any neurological deficits. In contrast, persistently elevated S-100B serum levels seem to be associated with transient loss of SSEP and development of neurological deficits.
Mussack
Thomas
T
Department of Surgery Innenstadt, Klinikum der Universität München, Nussbaumstrasse 20, D-80336 München, Germany. tmussack@helios.med.uni-muenchen.de
Biberthaler
Peter
P
Geisenberger
Thomas
T
Gippner-Steppert
Cornelia
C
Steckmeier
Bernd
B
Mutschler
Wolf
W
Jochum
Marianne
M
D000368:Aged; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D009418:S100 Proteins / Q000097:blood*
D009418:S100 Proteins