| Project/Area Number |
18390403
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| Research Category |
Grant-in-Aid for Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Cerebral neurosurgery
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| Research Institution | Iwate Medical University |
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Principal Investigator |
OGAWA Akira Iwate Medical University, School of Medicine, Professor (10204067)
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| Co-Investigator(Kenkyū-buntansha) |
OGASAWARA Kuniaki Iwate Medical University, School of Medicine, Associate Professor (00305989)
INOUE Takashi Iwate Medical University, School of Medicine, Part-time lecturer (70326651)
YOSHIDA Kenji Iwate Medical University, School of Medicine, Assistant Professor (10316367)
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| Project Period (FY) |
2006 – 2007
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| Project Status |
Completed (Fiscal Year 2007)
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| Budget Amount *help |
¥15,660,000 (Direct Cost: ¥15,000,000、Indirect Cost: ¥660,000)
Fiscal Year 2007: ¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
Fiscal Year 2006: ¥12,800,000 (Direct Cost: ¥12,800,000)
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| Keywords | Arterial sclerosis / Cervical carotid artery stenosis / Cerebral artery stenosis / Oxidative stress / Free radical / MRI / Phenotinic modulation / transcrintion factor / 頚部内頚動脈狭窄 / 脳循環 / 一塩基多型 / 血管平滑筋細胞 |
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| Research Abstract |
OBJECTIVE: Approximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CFA correlates with development of postoperative cognitive impairment. METHODS: Fifty-five patients undergoing CEA were assessed with a battery of neuropsychological tests before and 1 month after surgery. Serum samples for measurement of MDA-LDL concentration were obtained from a venous catheter inserted into the ipsilateral jugular bulb at the following time points: immediately before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA RESULTS: The MDA-LDL concentrations at 5 and 20 minutes after ICA declamping were both significantly higher than concentrations before IC
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Aclamping (P < 0.0001). At the postoperative neuropsychological assessment, six (11%) out of 55 patients showed postoperative cognitive impairment Logistic regression analysis demonstrated that higher values of MDA-LDL increase (calculated as a percentage of the preclamp values)at either 5 or 20 minutes after ICA declamping were significantly associated with the development of postoperative cognitive impairment(95% confidence interval, 0.787-0.981; P = 0.0209)among the variables tested. CONCLUSION: MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairment
BACKGROUND AND PURPOSE: The purpose of the present study was to determine whether preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy (CEA) correlate with development of postoperative cerebral hyperperfusion. METHODS: Concentrations of malondialdehyde-modified low-density lipoprotein (MDA-LDL), a biochemical marker of oxidative damage, were measured in serum samples obtained from 90 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Serum samples were obtained from a venous catheter inserted into the ipsilateral jugular bulb before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were also measured using single-photon emission computed-tomography before CEA In addition, CBF was measured postoperatively. RESULTS: Hyperperfusion (CBF increase >100% compared with preoperative values)was observed immediately after CEA in 12 patients (13%). logistic regression analysis demonstrated that reduced preoperative CVR (95% CIs, 1.053 to 1.453; P=0.0097) and an increase in MDA-LDL (calculated as a percentage of the preclamp values) after. ICA declamping (95% Cis, 0.862 to 0.980; P=0.0098) were significantly associated with development of postoperative cerebral hyperperfusion among the variables tested. Ten of 11 patients with reduced preoperative CVR and increased MDA-LDL after ICA declamping developed post-CEA hyperperfusion, and 2 of these patients developed cerebral hyperperfusion syndrome. CONCLUSIONS: Both preparative cerebral hemodynamic impairment and reactive oxygen species produced during surgery correlate with development of cerebral hyperperfusion after CEA. Less
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