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Licensed Unlicensed Requires Authentication Published by De Gruyter August 12, 2014

S100B concentrations increase perioperatively in jugular vein blood despite limited metabolic and inflammatory response to clinically uneventful carotid endarterectomy

  • Berndt Arfvidsson , Torbjörn K. Nilsson EMAIL logo and Lars Norgren

Abstract

Background: Our aim was to test the hypothesis that metabolic and inflammatory responses of the brain perioperatively during carotid endarterectomy (CEA) might affect blood brain barrier (BBB) integrity.

Methods: Twenty patients with >70% stenosis of internal carotid artery (ICA) were prospectively included. Surgery was performed under general anaesthesia. Blood was sampled from ipsilateral internal jugular vein and radial artery: just before, during, and after ICA clamping S100B protein, glucose, lactate, 20 amino acids, and key cytokines were analysed.

Results: Jugular vein S100B increased during clamping and reperfusion, while a marginal systemic increase was recorded, unrelated to stump pressure during clamping. Glucose increased during clamping in jugular vein blood and even more systemically, while jugular lactate values were higher than systemic values initially. Most amino acids did not differ significantly between jugular vein and systemic levels: glutamic acid and aspartic acid decreased during surgery while asparagine increased. Jugular vein interleukin (IL)-6 showed a transient non-significant increase during clamping and decreased systemically. IL-8 and IL-10 increased over time.

Conclusions: Rising jugular vein S100B concentrations indicated reduced BBB integrity, and marginal secondary increase of S100B systemically. Limited ischaemic effects on the brain during cross-clamping, unrelated to S100B concentrations, were confirmed by lower brain glucose levels and higher lactate levels than in systemic blood. The lack of increased jugular vein glutamic acid disproves any major ischaemic brain injury following CEA. The inflammatory response was limited, did not differ greatly between jugular and systemic blood, and was unrelated to S100B.


Corresponding author: Professor Torbjörn K. Nilsson, MD PhD, Department of Medical Biosciences/Clinical Chemistry, Umeå University, 90185 Umeå, Sweden, Phone: +46706082769, E-mail:

Acknowledgments

We thank Professor Gunnar Ronquist, Uppsala for his helpful comments on our draft. Financial support by the Research Committee of Örebro County Council and by Örebro University is gratefully acknowledged.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Björn Stenberg, MD, PhD contributed considerably to the surgical procedures and Mr. Ole Brus provided expert statistical advice. Elisabet Eriksson skilfully managed all sampling procedures.

Financial support: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material

The online version of this article (DOI: 10.1515/cclm-2014-0283) offers supplementary material, available to authorized users.


Received: 2014-3-13
Accepted: 2014-7-11
Published Online: 2014-8-12
Published in Print: 2015-1-1

©2015 by De Gruyter

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