title: Protein S-100B as biochemical marker of brain ischemic damage after treatment of carotid stenosis.
abstract: BACKGROUND
  S-100 protein is a family of low molecular weight proteins found in vertebrates characterized by two calcium binding sites of the helix-loop-helix ("EF-hand type") conformation. There are at least 21 different types of S-100 proteins. The name is derived from the fact that the protein is 100% soluble in ammonium sulfate at neutral pH. Protein S-100B was investigated as a marker of brain ischemic damage after treatment of carotid stenoses.
  
  
  METHODS
  Between December 1, 2009 and December 1, 2010, S-100B protein was monitored in 76 patients after carotid artery stenting (CAS) and in 24 patients after carotid endarterectomy (CEA). In each patient, multiple samples were taken: before the procedure (basal sample), immediately after CAS or CEA, 60 minutes after CAS or CEA, and daily during the hospital stay. Evaluation of S-100B was carried out by blind assessment. Patients underwent pre- and postoperative diffusion-weighted magnetic resonance imaging or computed tomographic scan.
  
  
  RESULTS
  An S-100B coefficient of variation higher than the established cut-off was detected in 16 patients: three affected by postoperative stroke, two patients with minor stroke, and one patient with fatal stroke; 12 patients presented with uneventful neurological outcome and positive brain imaging; and there was one false positive case. No false negative cases occurred. The postoperative protein S-100B level lowered to basal level in 15 patients: within 24 hours in the 12 patients with the uneventful outcome (and positive brain imaging) and in the false positive case; and after 120 and 144 hours, respectively, in the two patients with minor stroke. In the patient with fatal stroke, protein S-100B never returned to the preoperative level.
  
  
  CONCLUSIONS
  In patients with an increased S-100B coefficient of variation, the diffusion-weighted magnetic resonance imaging was positive for ischemic brain lesions, except for one patient who was reported as a false positive case. The postoperative S-100B protein level decreased within 24 hours in the uneventful neurological cases and in the false positive case, whereas long-lasting postoperative increased values of the S-100B protein were observed in patients with poor neurological outcomes.
authors.affiliation: Unit of Vascular and Endovascular Surgery, Annunziata Hospital, Cosenza, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Scarcello
authors.forename: Francesco
authors.initials: F
authors.lastname: Morrone
authors.forename: Paolo
authors.initials: P
authors.lastname: Piro
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tarsitano
authors.forename: Francesco
authors.initials: F
authors.lastname: Intrieri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Vaccarella
authors.forename: Emilio
authors.initials: E
authors.lastname: Guerra
authors.forename: Raffaele
authors.initials: R
authors.lastname: Serra
authors.forename: Stefano
authors.initials: S
authors.lastname: de Franciscis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016893:Carotid Stenosis / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood*; D011237:Predictive Value of Tests; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D012680:Sensitivity and Specificity; D015607:Stents; D020521:Stroke / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins