Research on the progression mechanism in arteriosclerotic lesion at the cervical and cerebral artery

点击翻译按钮获取中文摘要

OBJECTIVE: Approximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CFA correlates with development of postoperative cognitive impairment. METHODS: Fifty-five patients undergoing CEA were assessed with a battery of neuropsychological tests before and 1 month after surgery. Serum samples for measurement of MDA-LDL concentration were obtained from a venous catheter inserted into the ipsilateral jugular bulb at the following time points: immediately before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA RESULTS: The MDA-LDL concentrations at 5 and 20 minutes after ICA declamping were both significantly higher than concentrations before IC … More Aclamping (P < 0.0001). At the postoperative neuropsychological assessment, six (11%) out of 55 patients showed postoperative cognitive impairment Logistic regression analysis demonstrated that higher values of MDA-LDL increase (calculated as a percentage of the preclamp values)at either 5 or 20 minutes after ICA declamping were significantly associated with the development of postoperative cognitive impairment(95% confidence interval, 0.787-0.981; P = 0.0209)among the variables tested. CONCLUSION: MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairmentBACKGROUND AND PURPOSE: The purpose of the present study was to determine whether preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy (CEA) correlate with development of postoperative cerebral hyperperfusion. METHODS: Concentrations of malondialdehyde-modified low-density lipoprotein (MDA-LDL), a biochemical marker of oxidative damage, were measured in serum samples obtained from 90 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Serum samples were obtained from a venous catheter inserted into the ipsilateral jugular bulb before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were also measured using single-photon emission computed-tomography before CEA In addition, CBF was measured postoperatively. RESULTS: Hyperperfusion (CBF increase >100% compared with preoperative values)was observed immediately after CEA in 12 patients (13%). logistic regression analysis demonstrated that reduced preoperative CVR (95% CIs, 1.053 to 1.453; P=0.0097) and an increase in MDA-LDL (calculated as a percentage of the preclamp values) after. ICA declamping (95% Cis, 0.862 to 0.980; P=0.0098) were significantly associated with development of postoperative cerebral hyperperfusion among the variables tested. Ten of 11 patients with reduced preoperative CVR and increased MDA-LDL after ICA declamping developed post-CEA hyperperfusion, and 2 of these patients developed cerebral hyperperfusion syndrome. CONCLUSIONS: Both preparative cerebral hemodynamic impairment and reactive oxygen species produced during surgery correlate with development of cerebral hyperperfusion after CEA. Less