title: Concentration of matrix metalloproteinase-9 in the jugular bulb during carotid endarterectomy correlates with severity of intraoperative cerebral ischemia.
abstract: BACKGROUND
  Matrix metalloproteinase (MMP)-9 targets major components of the basal lamina of cerebral blood vessels and is a biochemical marker of blood-brain barrier disruption. The goal of this study was to determine whether plasma concentrations of MMP-9 in the jugular bulb during carotid endarterectomy (CEA) correlate with severity of intraoperative cerebral ischemia.
  
  
  METHODS
  In 41 patients undergoing CEA for ipsilateral internal carotid artery (ICA) stenosis, plasma samples for measurement of MMP-9 concentration were intraoperatively obtained from a venous catheter inserted into the ipsilateral jugular bulb. Transcranial cerebral oxygen saturation using near-infrared spectroscopy was also monitored intraoperatively to assess the severity of the ischemic insult during ICA clamping.
  
  
  RESULTS
  The MMP-9 concentrations were significantly higher after ICA declamping than before ICA clamping (p = 0.0023). A strong linear correlation was observed between the severity of the ischemic insult during carotid clamping and the increase in MMP-9 levels after ICA declamping (r = 0.776; p < 0.0001). At the postoperative neurological assessment, 3 patients showed transient minor neurological deficits. The MMP-9 level in the jugular bulb after ICA declamping was increased in patients with postoperative transient neurological deficits relative to those without.
  
  
  CONCLUSIONS
  The concentration of MMP-9 in the jugular bulb during CEA correlates with the severity of intraoperative cerebral ischemia.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Daiya
authors.initials: D
authors.lastname: Ishigaki
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Suga
authors.forename: Hideo
authors.initials: H
authors.lastname: Saito
authors.forename: Kohei
authors.initials: K
authors.lastname: Chida
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Otawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D002546:Ischemic Attack, Transient / Q000209:etiology*; D007601:Jugular Veins / Q000201:enzymology*; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D019265:Spectroscopy, Near-Infrared
chemical_list: D020780:Matrix Metalloproteinase 9; D010100:Oxygen