title: Fluctuations of serum neuron specific enolase and protein S-100B concentrations in relation to the use of shunt during carotid endarterectomy.
abstract: OBJECTIVE
  To evaluate the changes in serum neuron specific enolase and protein S-100B, after carotid endarterectomy performed using the conventional technique with routine shunting and patch closure, or eversion technique without the use of shunt.
  
  
  METHODS
  Prospective non-randomized study included 43 patients with severe (>80%) carotid stenosis undergoing carotid endarterectomy in regional anesthesia. Patients were divided into two groups: conventional endarterectomy with routine use of shunt and Dacron patch (csCEA group) and eversion endarterectomy without the use of shunt (eCEA group). Protein S-100B and NSE concentrations were measured from peripheral blood before carotid clamping, after declamping and 24 hours after surgery.
  
  
  RESULTS
  Neurologic examination and brain CT findings on the first postoperative day did not differ from preoperative controls in any patients. In csCEA group, NSE concentrations decreased after declamping (P<0.01), and 24 hours after surgery (P<0.01), while in the eCEA group NSE values slightly increased (P=ns), accounting for a significant difference between groups on the first postoperative day (P=0.006). In both groups S-100B concentrations significantly increased after declamping (P<0.05), returning to near pre-clamp values 24 hours after surgery (P=ns). Sub-group analysis revealed significant decline of serum NSE concentrations in asymptomatic patients shunted during surgery after declamping (P<0.05) and 24 hours after surgery (P<0.01), while no significant changes were noted in non-shunted patients (P=ns). Decrease of NSE serum levels was also found in symptomatic patients operated with the use of shunt on the first postoperative day (P<0.05). Significant increase in NSE serum levels was recorded in non-shunted symptomatic patients 24 hours after surgery (P<0.05).
  
  
  CONCLUSIONS
  Variations of NSE concentrations seemed to be influenced by cerebral perfusion alterations, while protein S-100B values were unaffected by shunting strategy. Routine shunting during surgery for symptomatic carotid stenosis may have the potential to prevent postoperative increase of serum NSE levels, a potential marker of brain injury.
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Marko
authors: M
authors: Dragas
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Igor
authors: I
authors: Koncar
authors: Faculty of Health, Medicine and Life Sciences, Department of Physiology, Maastricht University, Maastricht, The Netherlands.
authors: Dragan
authors: D
authors: Opacic
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Nikola
authors: N
authors: Ilic
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Zivan
authors: Z
authors: Maksimovic
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Miroslav
authors: M
authors: Markovic
authors: Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurology, Clinical Centre of Serbia, Belgrade, Serbia.
authors: Marko
authors: M
authors: Ercegovac
authors: Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Tatjana
authors: T
authors: Simic
authors: Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Marija
authors: M
authors: Pljesa-Ercegovac
authors: Clinic for Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors: Lazar
authors: L
authors: Davidovic
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000097:blood* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011093:Polyethylene Terephthalates; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D065506:Vascular Closure Devices
chemical_list: D011093:Polyethylene Terephthalates; D064568:S100 Calcium Binding Protein beta Subunit; D010751:Phosphopyruvate Hydratase