title: Neural damage biomarkers during open carotid surgery versus endovascular approach.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) is the gold standard for treating severe carotid artery stenosis, whereas carotid artery stenting (CAS) represents an endovascular alternative. The objective of this study was to assess the potential neural damage following open or endovascular carotid surgery measured by peripheral blood concentration of 3 biomarkers: S100β, matrix metalloproteinase-9 (MMP-9), and d-dimer.
  
  
  METHODS
  Data for this prospective investigation were obtained from the Carotid Markers study (January 2010-2011), which sought to measure the levels of specific biomarkers of neuronal damage and thrombosis on candidates to CEA or CAS presenting at the Department of Vascular Surgery of the Nuovo Ospedale S. Agostino Estense of Modena (Italy) at baseline and at 24 hr after surgery. Relevant medical comorbidities were noted.
  
  
  RESULTS
  A total of 113 consecutive patients were enrolled in the study, 41 in the endarterectomy group and 72 in the endovascular group. The baseline levels of the studied biomarkers did not show any statistically significant difference between the groups with the exception of MMP-9, which showed higher concentrations in the endovascular group (median 731 vs. 401, P = 0.0007), while 24 hr after surgery the endarterectomy group featured significantly higher peripheral blood concentrations of MMP-9, S100β, and d-dimer. Conversely, no significant difference was detected in the endovascular group except the d-dimer level.
  
  
  CONCLUSIONS
  Neural damage biomarkers demonstrated a substantial difference between open and endovascular carotid surgery, which, if performed in selected patients, may become a less invasive alternative to CEA.
authors.affiliation: School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Giuliani
authors.affiliation: Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Genedani
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Moratto
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Veronesi
authors.affiliation: Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Carone
authors.affiliation: School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Bonvecchio
authors.affiliation: School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mosca
authors.affiliation: Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Gioachino
authors.initials: G
authors.lastname: Coppi
authors.affiliation: School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: alberto.barbieri@unimore.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barbieri
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001927:Brain Diseases / Q000097:blood*; D016893:Carotid Stenosis / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D016894:Endarterectomy, Carotid; D057510:Endovascular Procedures; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; C036309:fibrin fragment D; D020780:Matrix Metalloproteinase 9