Perioperative Embolization Load and S-100β Do Not Predict Cognitive Outcome after Carotid Revascularization

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• 作者：Maarten Plessers¹ ; ² ; ^{Maarten.Plessers@UGent.be" class="auth_mail" title="E-mail the corresponding author} ; Isabelle Van Herzeele² ; Dimitri Hemelsoet³ ; Guy Vingerhoets¹ ; Frank Vermassen²
• 刊名：Annals of Vascular Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：175-181
• 全文大小：479 K

文摘

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.