title: Concentration of malondialdehyde-modified low-density lipoprotein in the jugular bulb during carotid endarterectomy correlates with development of postoperative cognitive impairment.
abstract: OBJECTIVE
  Approximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment. The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CEA correlates with development of postoperative cognitive impairment.
  
  
  METHODS
  Fifty-five patients undergoing CEA were assessed with a battery of neuropsychological tests before and 1 month after surgery. Serum samples for measurement of MDA-LDL concentration were obtained from a venous catheter inserted into the ipsilateral jugular bulb at the following time points: immediately before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA.
  
  
  RESULTS
  The MDA-LDL concentrations at 5 and 20 minutes after ICA declamping were both significantly higher than concentrations before ICA clamping (P < 0.0001). At the postoperative neuropsychological assessment, six (11%) out of 55 patients showed postoperative cognitive impairment. Logistic regression analysis demonstrated that higher values of MDA-LDL increase (calculated as a percentage of the preclamp values) at either 5 or 20 minutes after ICA declamping were significantly associated with the development of postoperative cognitive impairment (95% confidence interval, 0.787-0.981; P = 0.0209) among the variables tested.
  
  
  CONCLUSIONS
  MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairment.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saito
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Komoribayashi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Otawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000097:blood / Q000601:surgery*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000097:blood* / Q000209:etiology*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008315:Malondialdehyde / Q000031:analogs & derivatives* / Q000097:blood; D008875:Middle Aged; D009483:Neuropsychological Tests; D018384:Oxidative Stress / Q000502:physiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D008077:Lipoproteins, LDL; C502964:malondialdehyde-low density lipoprotein, mouse; D008315:Malondialdehyde