Concentration of matrix metalloproteinase-9 in the jugular bulb during carotid endarterectomy correlates with severity of intraoperative cerebral ischemia.
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.
Ishigaki
Daiya
D
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Ogasawara
Kuniaki
K
Suga
Yasunori
Y
Saito
Hideo
H
Chida
Kohei
K
Kobayashi
Masakazu
M
Yoshida
Kenji
K
Otawara
Yasunari
Y
Ogawa
Akira
A
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
D020780:Matrix Metalloproteinase 9; D010100:Oxygen