Assessment of Early Brain Damage in Carotid Endarterectomy: Evaluation of S‐100B Serum Levels and Somatosensory Evoked Potentials in a Pilot Study

• Published in: World journal of surgery 2002-10, Vol.26 (10), p.1251-1255
• Main Authors: Mussack, Thomas, Biberthaler, Peter, Geisenberger, Thomas, Gippner‐Steppert, Cornelia, Steckmeier, Bernd, Mutschler, Wolf, Jochum, Marianne
• Format: Article
• Language: English
• Subjects: Aged; Carotid Endarterectomy; Constriction; Endarterectomy, Carotid - adverse effects; Evoked Potentials, Somatosensory; Female; Humans; Hypoxia, Brain - blood; Hypoxia, Brain - physiopathology; Internal Carotid Artery; Male; Middle Aged; North American Symptomatic Carotid Endarterectomy Trial; Oral Intubation; Pilot Projects; Postoperative Period; S100 Proteins - blood; Shunt Insertion
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-002-6547-6

The release of the neuronal protein S‐100B into the circulation has been suggested as an early indication of cellular brain damage. The objective of this prospective pilot study was to determine S‐100B serum levels in patients undergoing cross‐clamping during carotid endarterectomy (CEA) and to correlate the results with the monitoring of somatosensory evoked potentials (SSEP) and the neurological short‐term outcome. Arterial blood samples of 21 patients were drawn before oral intubation, cross‐clamping, and unclamping, as well as before extubation and 6 hours later. Recording of SSEP was obtained during carotid occlusion and reperfusion. If loss of SSEP appeared, cerebral ischemia was assumed and an intraluminal shunt was placed. During cross‐clamping, S‐100B serum levels of 14 patients increased significantly from 0.05 ng/ml to 0.21 ng/ml, but returned to baseline levels after unclamping. In 5 cases, loss of SSEP amplitudes occurred but was reversed by the shunt insertion. No significant differences of S‐100B serum values, neurological examination, and carotid duplex surveillance became obvious in this group when compared to the patients with undisturbed SSEP. However, 2 patients with complete disappearance of postcentral SSEP components suffered from neurological deficits in the postoperative period. S‐100B serum levels remained highly elevated 6 hours after extubation (0.78 ng/ml and 0.41 ng/ml) compared to the baseline values (0.15 ng/ml and 0.07 ng/ml). During CEA a transitory increase of the S‐100B serum levels appears to present an impairment of the blood–brain barrier integrity without any neurological deficits. In contrast, persistently elevated S‐100B serum levels seem to be associated with transient loss of SSEP and development of neurological deficits.