OBJECTIVE-Cognitive decline occurs in 25% of patients after carotid endarterectomy (CEA). Elevated serum concentrations of S-100B and neuron-specific enolase (NSE) occur after stroke, and serum S-100B levels at 24 hours are associated with clinical outcome after both stroke and CEA. We hypothesized that we could detect acute elevations in serum levels of these markers obtained intraoperatively from the jugular bulb (JB) and that these elevations would predict cognitive dysfunction postoperatively as measured by neuropsychometric test performance.METHODS-Forty-three patients scheduled for elective CEA were assessed with a battery of neuropsychometric tests before and 1 day after surgery. Before the carotid artery was clamped, a 6-French Fogarty catheter was inserted into the facial vein and threaded 6 cm rostrally into the JB. Serum samples were withdrawn from this catheter and simultaneously from a radial arterial catheter (A-line) at three time points: before clamping, 15 minutes into clamping, and after unclamping the carotid artery. Concentrations between groups were compared by analysis of variance and paired t tests.RESULTS-Total deficit scores were significantly worse in 13 (30%) of the 43 patients 1 day after surgery. There was a trend toward elevations in JB concentrations of S-100B relative to A-line levels 15 minutes after cross-clamping (11% elevation, P = 0.079, paired t test). In addition, 15 minutes NIH Public Access
Author ManuscriptNeurosurgery. Author manuscript; available in PMC 2009 March 31.
Published in final edited form as:Neurosurgery. 2003 December ; 53(6): 1243-1250.
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript after clamping of the carotid artery, levels of S-100B from the JB were significantly elevated Robert J. Dempsey Madison, Wisconsin 1. Connolly ES Jr, Winfree CJ, Rampersad A, Sharma R, Mack WJ, Mocco J, Solomon RA, Todd G, Quest DO, Stern Y, Heyer EJ: Serum S100B protein levels are correlated with subclinical neurocognitive declines after carotid endarterectomy. Neurosurgery 49: [1076][1077][1078][1079][1080][1081][1082][1083] 2001. The authors tested the hypothesis that changes in serum S-100B and NSE during endarterectomy may predict post-operative cognitive dysfunction. This hypothesis is based on literature linking these two proteins (which are normally found in the brain extracellular space) to brain damage; several reports have shown that both serum markers were elevated after head injury, ischemia, cardiac arrest, etc. The fact that S-100B (but not NSE) is also elevated after a variety of conditions not associated with any "brain damage" (e.g., running a marathon, mild depression) led our laboratory to formulate the hypothesis that S-100B is a marker of BBB leakage, even in the absence of neuronal damage. This was confirmed in patients with primary central nervous system lymphoma who were undergoing iatrogenic BBB disruption with mannitol. After administration of mannitol, there was an immediate increase in S-100B serum levels, which re...