Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

Connolly, E. Sander; Winfree, Christopher J.; Rampersad, Anita; Sharma, Ruchey; Mack, William J.; Mocco, J; Solomon, Robert A.; Todd, George J.; Quest, Donald O.; Stern, Yaakov; Heyer, Éric

doi:10.1097/00006123-200111000-00010

Cited by 39 publications

(26 citation statements)

References 31 publications

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“…However, this study is the first to evaluate NLR in a cohort of patients undergoing CEA and to determine whether NLR is predictive of cognitive dysfunction. Cognitive dysfunction, though less clinically momentous than stroke, has been associated with markers of brain injury 3 and mortality 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of stroke during the perioperative period of CEA is 3–5%, a subtler form of neurologic injury, cognitive dysfunction, is exhibited in approximately 25% of patients 1 day after CEA 1, 2 . Cognitive dysfunction has been associated with markers of brain injury 3 and earlier retirement and mortality 4 . While the underlying cause of the cognitive dysfunction is likely multifactorial, previous studies suggest that systemic inflammation plays an important role 5–9 .…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients

Halazun

Mergeche

Mallon

et al. 2014

Journal of Vascular Surgery

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Background Systemic inflammation has been implicated in the development of cognitive dysfunction following carotid endarterectomy (CEA). Neutrophil-lymphocyte ratio (NLR) is a reliable measure of systemic inflammation. We hypothesize that patients with elevated preoperative NLR have increased risk of cognitive dysfunction 1 day after CEA. Methods Five hundred fifty-one (551) patients scheduled for CEA were enrolled at Columbia University in New York, NY from 1995 to 2012. NLR was retrospectively reviewed; only 432 patients had preoperative NLR values available within 2 weeks of CEA. NLR was analyzed as a continuous variable and categorically with a cutoff of ≥5 and <5 and equal tertiles, as done in previous studies. Results Patients with cognitive dysfunction had significantly higher NLR than those without cognitive dysfunction (4.5±4.0 vs. 3.2±2.6, P<0.001). The incidence of cognitive dysfunction was significantly higher in patients with NLR ≥5 than NLR <5 (34.7% vs. 12.8%, P<0.001). Significantly fewer patients in the low tertile had cognitive dysfunction than in the high tertile (6.9% vs. 25.9%, P<0.001) and middle tertile (6.9% vs. 17.4%, P=0.006). In the final multivariate model, diabetes mellitus (OR: 2.03 [1.08–3.75], P=0.03) and NLR ≥5 (OR: 3.38 [1.81–6.27], P<0.001) were significantly associated with higher odds of cognitive dysfunction, while statin use was significantly associated with lower odds (OR: 0.48 [0.27–0.84], P=0.01). Conclusions Preoperative NLR is associated with cognitive dysfunction 1 day after CEA. NLR ≥5 and diabetes mellitus are significantly associated with increased odds of cognitive dysfunction while statin use is significantly associated with decreased odds.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients

Halazun

Mergeche

Mallon

et al. 2014

Journal of Vascular Surgery

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“…Previous work has demonstrated that patients with cognitive dysfunction have significantly elevated markers of neuronal injury(17), reduced quality of life, and early mortality(16) following surgery. Therefore, TCD assessment of MCA–MV during CEA may be an appropriate approach to reducing the risk of cognitive dysfunction after surgery and further improving the safety of CEA.…”

Section: Discussionmentioning

confidence: 99%

“…Though less clinically momentous than stroke, postoperative cognitive dysfunction has significant implications for quality of life and early mortality(16). Glial markers of neuronal injury are significantly elevated in CEA patients that exhibit cognitive dysfunction as early as 24 hours after CEA(17). In our previous work, we documented that approximately a quarter of CEA patients exhibit cognitive dysfunction 24 hours after CEA(18, 19).…”

Section: Introductionmentioning

confidence: 99%

Reduced middle cerebral artery velocity during cross-clamp predicts cognitive dysfunction after carotid endarterectomy

Mergeche

Bruce

Connolly

et al. 2014

Journal of Clinical Neuroscience

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Transcranial Doppler (TCD) is a useful monitor that can be utilized during carotid endarterectomy (CEA). Cognitive dysfunction is a subtler and more common form of neurologic injury than stroke. We aimed to determine whether reduced middle cerebral artery (MCA) mean velocity (MV) predicts cognitive dysfunction and if so, whether a threshold of increased risk of cognitive dysfunction can be identified. One hundred twenty-four CEA patients were included in this observational study and neuropsychometrically evaluated preoperatively and 24 hours postoperatively. MCA–MV was measured by TCD and percentage of baseline during cross-clamp was calculated (MVcross-clamp/MVbaseline). Patients with cognitive dysfunction had significantly lower MV during cross-clamp than those without cognitive dysfunction (33.1 ± 13.7 cm/s versus 39.6 ± 16.0 cm/s, p = 0.02). In the final multivariate model, each percent reduction in MV was significantly associated with greater risk of cognitive dysfunction (odds ratio [OR]: 0.05 [95% confidence interval {CI} 0.01–0.23], p < 0.001) while statin use was associated with lower risk (OR: 0.33 [95% CI 0.12–0.92], p = 0.03). Using receiver operator characteristic curve analysis, the Youden index identified 72% of baseline MV during cross-clamp as the cutoff of maximum discrimination. Significantly more patients with MV < 72% of baseline during cross-clamp exhibited cognitive dysfunction than patients with MV ≥ 72% of baseline (74.1% versus 27.1%, p < 0.001). Reduced MCA–MV during cross-clamp is a predictor of cognitive dysfunction exhibited 24 hours after CEA. MCA–MV reduced to < 72% of baseline, or a ≥ 28% reduction from baseline, is the threshold most strongly associated with increased risk of cognitive dysfunction. These observations should be considered by all clinicians that utilize intraoperative monitoring for CEA.

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“…Approximately a quarter of CEA patients demonstrate eCD 24hrs after CEA 8, 9 . It is a subtler form of neurologic injury than stroke and is similar to stroke in its pathophysiology; patients with eCD demonstrate significantly elevated markers of neuronal injury 10 as well as asymmetric cerebral blood flow on magnetic resonance perfusion brain scans 11 .…”

Section: Introductionmentioning

confidence: 99%

Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction

et al. 2014

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Background A common practice during cross-clamp of carotid endarterectomy (CEA) is to manage mean arterial pressure (MAP) above baseline to optimize collateral cerebral blood flow and reduce risk of ischemic stroke. Objective To determine whether MAP management ≥20% above baseline during cross-clamp is associated with lower risk of early cognitive dysfunction, a subtler form of neurologic injury than stroke. Methods One hundred eighty-three patients undergoing CEA were enrolled in this ad hoc study. All patients had radial arterial catheters placed prior to induction of general anesthesia. MAP was managed at the discretion of the anesthesiologist. All patients were evaluated with a battery of neuropsychometric tests pre-operatively and 24hrs post-operatively. Results Overall, 28.4% of CEA patients exhibited early cognitive dysfunction (eCD). Significantly fewer patients with MAP ≥20% above baseline during cross-clamp exhibited eCD than those managed <20% above (11.6% vs. 38.6%, P<0.001). In a multivariate logistic regression model, MAP ≥20% above baseline during the cross-clamp period was associated with significantly lower risk of eCD (OR: 0.18 [0.07–0.40], P<0.001), while diabetes mellitus (OR: 2.73 [1.14–6.61], P=0.03) and each additional year of education (OR: 1.19 [1.06–1.34], P=0.003) were associated with significantly higher risk of eCD. Conclusion The observations of this study suggest MAP management ≥20% above baseline during cross-clamp of the carotid artery may be associated with lower risk of eCD after CEA. More prospective work is necessary to determine whether MAP ≥20% above baseline during cross-clamp can improve the safety of this commonly performed procedure.

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Serum S100B Protein Levels Are Correlated with Subclinical Neurocognitive Declines after Carotid Endarterectomy

Cited by 39 publications

References 31 publications

Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients

Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients

Reduced middle cerebral artery velocity during cross-clamp predicts cognitive dysfunction after carotid endarterectomy

Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction

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