Giuliani Enrico, Genedani Susanna, Moratto Roberto, Veronesi Jessica, Carone Chiara, Bonvecchio Cinzia, Mosca Francesco, Coppi Gioachino, Barbieri Alberto
School of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
Deparment of Pharmacology, University of Modena and Reggio Emilia, Modena, Italy.
Ann Vasc Surg. 2014 Oct;28(7):1671-9. doi: 10.1016/j.avsg.2014.05.006. Epub 2014 Jun 6.
Carotid endarterectomy (CEA) is the gold standard for treating severe carotid artery stenosis, whereas carotid artery stenting (CAS) represents an endovascular alternative. The objective of this study was to assess the potential neural damage following open or endovascular carotid surgery measured by peripheral blood concentration of 3 biomarkers: S100β, matrix metalloproteinase-9 (MMP-9), and d-dimer.
Data for this prospective investigation were obtained from the Carotid Markers study (January 2010-2011), which sought to measure the levels of specific biomarkers of neuronal damage and thrombosis on candidates to CEA or CAS presenting at the Department of Vascular Surgery of the Nuovo Ospedale S. Agostino Estense of Modena (Italy) at baseline and at 24 hr after surgery. Relevant medical comorbidities were noted.
A total of 113 consecutive patients were enrolled in the study, 41 in the endarterectomy group and 72 in the endovascular group. The baseline levels of the studied biomarkers did not show any statistically significant difference between the groups with the exception of MMP-9, which showed higher concentrations in the endovascular group (median 731 vs. 401, P = 0.0007), while 24 hr after surgery the endarterectomy group featured significantly higher peripheral blood concentrations of MMP-9, S100β, and d-dimer. Conversely, no significant difference was detected in the endovascular group except the d-dimer level.
Neural damage biomarkers demonstrated a substantial difference between open and endovascular carotid surgery, which, if performed in selected patients, may become a less invasive alternative to CEA.
颈动脉内膜切除术（CEA）是治疗严重颈动脉狭窄的金标准，而颈动脉支架置入术（CAS）是一种血管腔内替代方法。本研究的目的是通过检测3种生物标志物（S100β、基质金属蛋白酶-9（MMP-9）和D-二聚体）的外周血浓度，评估开放性或血管腔内颈动脉手术后潜在的神经损伤。
这项前瞻性研究的数据来自颈动脉标志物研究（2010年1月至2011年），该研究旨在测量意大利摩德纳新圣阿戈斯蒂诺埃斯滕塞医院血管外科就诊的CEA或CAS候选患者在基线和术后24小时神经元损伤和血栓形成的特定生物标志物水平。记录相关的内科合并症。
共有113例连续患者纳入研究，内膜切除术组41例，血管腔内组72例。除MMP-9外，研究的生物标志物基线水平在两组之间未显示任何统计学显著差异，MMP-9在血管腔内组浓度较高（中位数731对401，P = 0.0007），而术后24小时内膜切除术组MMP-9、S100β和D-二聚体的外周血浓度显著更高。相反，血管腔内组除D-二聚体水平外未检测到显著差异。
神经损伤生物标志物在开放性和血管腔内颈动脉手术之间显示出实质性差异，如果在选定患者中进行，血管腔内手术可能成为CEA的一种侵入性较小的替代方法。
