S-100B release during carotid endarterectomy under local anesthesia

Area of Science:

• Neurosurgery
• Neurology
• Biomarkers

Background:

• S-100B protein is a known indicator of cellular brain damage.
• Previous studies reported a 120% increase in S-100B during carotid endarterectomy (CEA) under general anesthesia.

Purpose of the Study:

• To evaluate S-100B release patterns during CEA performed under local anesthesia.
• To compare S-100B release under local anesthesia with previously reported findings under general anesthesia.

Main Methods:

• 45 patients undergoing CEA under local anesthesia had serum S-100B levels measured at five time points (pre-surgery, pre-cross-clamping, pre-reperfusion, post-reperfusion, 6-hr post-op).
• Blood samples were collected from both radial artery and internal jugular vein intraoperatively.
• S-100B levels were quantified using an immunoluminometric assay (LIAISON Sangtec 100).

Main Results:

• No significant increase in S-100B levels was observed during carotid cross-clamping in patients undergoing CEA under local anesthesia.
• Slight increases (13-18%) in S-100B were transient and followed by decreases, with no difference between arterial and venous samples.
• S-100B release did not differ between patients requiring an intraluminal shunt and those who did not.

Conclusions:

• Uncomplicated CEA under local anesthesia is not associated with a relevant increase in S-100B, suggesting minimal neuronal injury.
• These findings contrast with the significant S-100B elevation reported for CEA performed under general anesthesia.
• Local anesthesia appears to be a safer alternative regarding S-100B release during carotid endarterectomy.