title: Perioperative Embolization Load and S-100β Do Not Predict Cognitive Outcome after Carotid Revascularization.
abstract: BACKGROUND
  Cognitive changes after carotid revascularization have been reported in 10-20% of patients. The etiology of cognitive impairments remains largely unknown. This study evaluates the predictive value of S-100β serum values and perioperative microembolization on cognition after carotid revascularization.
  
  
  METHODS
  Forty-six patients with significant carotid stenosis underwent carotid endarterectomy (CEA, n = 26), transfemoral carotid artery stenting with distal protection (CASdp, n = 10), or transcervical carotid stenting with dynamic flow reversal (CASfr, n = 10). Twenty-six matched vascular patients without carotid stenosis were recruited as controls. All patients underwent comprehensive cognitive testing on the day before and 1 month after carotid revascularization. S-100β analysis was performed in 31 cases pre-, peri-, and 2, 6, and 24 hr after carotid surgery, and in 25 patients transcranial Doppler monitoring was done during surgery.
  
  
  RESULTS
  In the 3 treatment groups similar transient increases in S-100β values were observed. CASdp was associated with a higher embolic load than CEA and CASfr, while CEA was also associated with less microembolization than CASfr. Cognitive improvement or deterioration could not be predicted by S-100β or perioperative embolic load for any of the investigated cognitive domains.
  
  
  CONCLUSIONS
  Cognitive deterioration could not be predicted using perioperative embolic load and S-100β changes. A similar inverted u-curve of the S-100β levels was observed in the 3 groups and may be caused by impairment in the blood-brain barrier during intervention, and not due to cerebral infarction. Distal protection CAS is associated with a higher embolic load than transcervical CAS using dynamic flow reversal and CEA, but the long-term impact of this higher embolic load is yet unknown. Perfusion-related measures seem promising in their ability to predict cognitive decline.
authors.affiliation: Department of Experimental Psychology, Ghent University, Ghent, Belgium; Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: Maarten.Plessers@UGent.be.
authors.forename: Maarten
authors.initials: M
authors.lastname: Plessers
authors.affiliation: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van Herzeele
authors.affiliation: Department of Neurology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Hemelsoet
authors.affiliation: Department of Experimental Psychology, Ghent University, Ghent, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Vingerhoets
authors.affiliation: Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Vermassen
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D012307:Risk Factors; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human