Serum S-100B protein levels during and after successful carotid artery stenting or carotid endarterectomy.
OBJECTIVE
To characterize the course of S-100B serum levels, a reliable marker for cellular brain damage, in patients undergoing carotid artery stenting (CAS) or endarterectomy (CEA) for carotid artery stenosis compared to control groups undergoing hemithyroidectomy (HT) or coronary angiography (CA).


METHODS
Forty-six consecutive patients scheduled for revascularization of internal carotid artery (ICA) stenosis were included in the study. Fourteen patients (11 men; median age 70 years, interquartile range [IQR] 63-74) were selected for treatment with CAS, while CEA was performed in 31 patients (24 men; median age 68 years, IQR 54-78) during the same time period. Fourteen consecutive patients (8 men; median age 60 years, IQR 48-70) undergoing CA for suspected coronary heart disease and 14 patients (10 women; median age 36 years, IQR 26-54) undergoing HT for a single thyroid nodule served as controls.


RESULTS
All procedures were completed successfully. During ICA clamping in CEA patients without postoperative neurological deficits, median S-100B serum levels transiently increased from 0.04 to 0.26 ng/mL (p<0.01) and returned to baseline levels after declamping. Median S-100B serum levels of CAS patients without neurological impairment remained at baseline values. No increase in S-100B levels occurred in either control group. Three CEA patients who suffered from neurological deficits (1 transient ischemic attack and 1 major stroke) showed sustained elevation of S-100B serum levels 6 hours after extubation.


CONCLUSIONS
In patients without neurological complications, CEA but not CAS was associated with a transient increase in the S-100B serum levels. Results indicate that the increase in S-100B does not originate from extracerebral sources, but rather appears to represent an impairment of the blood-brain barrier integrity or subtle brain cell damage probably due to hypoperfusion during clamping. Sustained elevation of S-100B serum levels corresponded to the development of postoperative neurological deficits.
Mussack
Thomas
T
Department of General Surgery, Klinikum der Universität München, Germany. Thomas.Mussack@med.uni-muenchen.de
Hauser
Christopher
C
Klauss
Volker
V
Tató
Frederico
F
Rieger
Johannes
J
Ruppert
Volker
V
Jochum
Marianne
M
Hoffmann
Ulrich
U
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000097:blood / Q000601:surgery*; D017023:Coronary Angiography; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D009422:Nervous System Diseases / Q000097:blood / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood*; D011184:Postoperative Period; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D015607:Stents; D013965:Thyroidectomy; D013997:Time Factors
D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins