SS35. Comparative Study on Carotid Revascularization (CEA Versus CAS) Using Markers of Cellular Brain Injury, Neuropsychometric Tests and DW-MRI

Article Outline

• Objective
• Methods
• Results
• Conclusions
• Copyright

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Objective 

Subclinical alterations of cerebral function can occur during or after carotid revascularization and can be predict by simple tests administration. The aim of this comparative study is to assess the relationship between serum level of two biochemical markers of cerebral injury and post-operative DW-MRI and neuropsychometric testing (MMSE test) in two groups of patients submitted to carotid revascularization for high-grade stenosis.

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Methods 

Forty-three consecutive asymptomatic patients underwent carotid revascularization by endarterectomy (CEA=20) or stenting (CAS=23). They were submitted to diffusion-weighted magnetic resonance imaging (DW-MRI) and Mini-mental State Examination (MMSE) test pre-operatively and within 24 hours after carotid revascularization. Venous blood samples to assess serum levels of neuron-specific enolase (NSE) and S100β protein were collected for each patient pre-operatively and at five time points in a 24-hour post-operative period, and then assayed using automated commercial equipment. Relationship between serum markers levels and neuropsychometric and imaging tests and differences between the two groups of patients were analyzed by chi-square test with significance at p<0.05.

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Results 

No TIA or strokes were clinically observed in the two groups. CAS caused more new subcortical lesions at post-operative DW-MRI (p=0.04) and a significant decline in MMSE post-operative score (p=0.045) compared to CEA. In CAS patients new lesions at DW-MRI were significantly associated with MMSE score decline greater than 5 points (p=0.03). Analysis of S100β and NSE levels showed a significant increase at 24 hours in CAS group compared to the CEA group (p=0.035).

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Conclusions 

Biochemical markers measurements of brain damage combined with neuropsychometric tests and DW-MRI can be used to evaluate silent post-CAS injuries. In CAS the mechanisms of rise in S-100β and NSE levels at 24 hours may be due to increased peri-operative micro-embolisation rather than to hypoperfusion. Further studies are required to assess the clinical significance and cost effectiveness of those tests in carotid revascularization.