ABSTRACT
Background & objectives: Ischaemic stroke is a life burdening disease for which carotid endarterectomy (CEA) is considered a gold standard intervention. Pro-inflammatory markers like matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) and S-100 Beta (S100B) may have a role in the early inflammation and cognitive decline following CEA. This study was aimed to describe the perioperative time courses and correlations between of MMP-9, TIMP-1 and S100B following CEA. Methods: Fifty four patients scheduled for CEA were enrolled. Blood samples were collected at four time points, T1: preoperative, T2: 60 min after cross-clamp release, T3: first postoperative morning, T4: third postoperative morning. Twenty atherosclerotic patients were included as controls. Plasma MMP-9, TIMP-1 and S100B levels were estimated by ELISA. Results: TIMP-1 was decreased significantly in the CEA group (P<0.01). Plasma MMP-9 was elevated and remained elevated from T1-4 in the CEA group (P<0.05) with a marked elevation in T3 compared to T1 (P<0.05). MMP-9/TIMP-1 was elevated in the CEA group and increased further by T2 and T3 (P<0.05). S100B was elevated on T2 and decreased on T3-4 compared to T1. Interpretation & conclusions: Our study provides information on the dynamic changes of MMP-9-TIMP-1 system and S100B in the perioperative period. Preoperative reduction of TIMP-1 might be predictive for shunt requirement but future studies are required for verification.
ABSTRACT
BACKGROUND AND OBJECTIVES: Detection and prevention of cerebral ischemia are some of the most important aspects in the surgical manipulation of the carotid artery. During the last several decades, various methods including analog EEG had been tried, but none of them proved to be satisfactory. MATERIALS AND METHODS: A new intraoperative EEG monitoring technique with compressed spectral array (CSA) monitoring was applied. With brain protection, patient's EEG was continuously monitored before and after carotid clamping. RESULTS: Each case of carotid endarterectomy, rupture of carotid and innominate artery, and carotid artery resection with vein graft was successfully managed without any neurological complication during and after the surgery. Average carotid clamping time was 59 minutes. Neither carotid bypass nor shunt was used in any cases. CONCLUSION: EEG monitoring with CSA technique was easy to read, easily applicable in the operating room, convenient to compare data before and after the carotid clamping, and it showed data continuously for 9-18 minutes on a window. This technique was also very useful in emergency carotid surgery cases where no preoperative information about cerebral circulation were available.