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Glutathionyl-hemoglobin levels in carotid endarterectomy: a pilot study on 12 cases clinically uneventful
G Ghilardi1, F M Rubino, M Pitton
1Department of Medicine Surgery and Dentistry, University of Milan, Milan, Italy - giorgio.ghilardi@unimi.it.
Insights
Glutathionylated haemoglobin (HbSSG) levels in jugular blood increased during carotid clamping in some patients undergoing endarterectomy, suggesting cerebral protection mechanisms against oxidative stress.
Area of Science:
- Biochemistry
- Neuroscience
- Surgical Research
Background:
- Carotid endarterectomy is crucial for stroke prevention.
- Carotid clamping is a necessary surgical step.
- Glutathionylated haemoglobin (HbSSG) is a biomarker for oxidative stress, elevated in conditions like hypoxia.
Purpose of the Study:
- To investigate changes in HbSSG levels in peripheral and jugular blood during carotid endarterectomy.
- To assess the impact of carotid clamping on oxidative stress markers.
Main Methods:
- 13 patients undergoing carotid endarterectomy were studied.
- Blood samples were collected from peripheral and ipsilateral jugular veins.
- HbSSG levels were measured using MALDI-ToF mass spectrometry.
Main Results:
- Three patients exhibited complex HbSSG level fluctuations.
- Jugular blood HbSSG levels were approximately 30% higher than peripheral levels during carotid clamping.
- HbSSG levels returned to baseline within 2 minutes of clamp removal.
Conclusions:
- Carotid clamping can induce transient oxidative stress, indicated by rising jugular HbSSG levels in some patients.
- These findings suggest the involvement of endogenous cerebral protective mechanisms.
- HbSSG may serve as a marker for monitoring cerebral oxidative stress during carotid surgery.
Abstract:
Aim: Carotid endarterectomy is a widely accepted procedure for stroke prevention, and carotid clamping is a necessary surgical step. Glutathionylated haemoglobin (HbSSG) has been recently employed as a biomarker of oxidative stress, its level being increased under several conditions, including hypoxia. This study aims to evaluating whether HbSSG level in peripheral and/or jugular blood is affected during carotid surgery under normal routine operative conditions. Methods: This study enrolled 13 consecutive patients undergoing elective carotid endarterectomy under general anesthesia. At different times during surgery, blood was taken simultaneously from both a peripheral vein and the jugular vein ipsilateral to the clamped carotid. HbSSG was measured in RBC hemolysates by MALDI-ToF mass spectrometry in each sample. Results: Three patients showed a complex pattern of rise and fall of HbSSG levels in different time periods before, during and after surgery. They also showed statistically significant differences between peripheral and jugular blood, with mean HbSSG levels in jugular blood higher by approx. 30% than those of peripheral blood at the end of the period of carotid clamping. In all three patients HbSSG levels fell to pre-clamping values within 2 min from removal of carotid artery clamp. Conclusion: Although effective routine drug management allowed brain safety during carotid clamping time, a number of patients showed a fast modification over time of the HbSSG levels in jugular blood, suggesting that "resident" cerebral biochemical protection mechanisms could play some role to compensate clinically silent brain oxidative stress.