The NSE And S100B Protein To Assess The Ischemia-reperfusion Injury After The CAS With Small Acute Cerebral Infarction

Object:To assess the situation of the reperfusion injury after the carotid artery stenting(CAS) with small acute ischemic stroke and draw the theoretical basis for selecting the time window of Clinical operation.Materials and methods: 35 patients who were underwent CAS with the unilateral carotid arterial stenosis between the January in 2014 to the January in 2016 were collected. The stenosis was between 70% to 99%. According to the MRI images of preoperation and postoperation and the time window of the operation, the patients were divided into two groups. One group is the Infarction Group(small acute infarction) with 16 patients collected, another group the Control Group(no acute infraction) with 19 patients collected. The veinal blood was taken from the elbow vein at two different time points which were 2 hours before the CAS and 72 hours after the CAS. The ELISA methods were adopted to test the Neuron Specific Enolase(NSE)、the S100 B protein and the Superoxide Dismutase(SOD) in serum. The indexes of the two groups were compared within groups and between groups. Moreover, according to the symptoms of the patients after the CAS,the patients were divided into two groups: the Symptom Changed Group(14 patients)and the symptom Unchanged Group(21 patients). Compare the general clinical data, the levels of NSE and the S100 B protein in serum within groups and between groups. The enumeration data were tested by chi-square and the measurement data are analyzed by T-test. The independent sample T-test was used to evaluate the difference between the different groups and the paired samples T-test was used to evaluate the difference between subgroups within the same group. The results were considered significant when p-values were less than 0.05.Results:35 patients were ungerwent the CAS successfully with 38 stents were implanted.There were no adverse events happened in the perioperative period.1. There were no statistical difference between the Infarction Group and the Control Groups in the sex, age, hypertension, diabetes, hyperlipoidemia and the stenosis of the target vessel(P>0.05). There was statistical difference in the volume of the acute infarciton and the NIHSS score preoperation between the two groups(P<0.01).2. The SOD levels in the postoperation showed a significant decrease compared with the preoperation within the two groups(P<0.01). The changes of SOD levels between the two groups had no statistical difference. All these indirectly showed that the CAS can significantly increase cerebral reperfusion, improving the blood supply to the brain.3. To compare the NSE and S100 B protein levels between and within the two groups, we found the level of NSE in Infarction Group was higher than the Control Group in postoperation(P<0.05),but both the numbers were in the normal reference value range. There were no statistical difference between the other indexes.All these showed that the CAS won’t cause severe brain injury in the acute stage in the patients with samll area infarction.But the patients with no acute infarction will have a better prognosis.4. There were no statistical difference between the Symptom Changed Group and the Symptom Unchanged Group in age, sex, hyperlipoidemia,the infraction and the NIHSS score preoperation(P>0.05).But the statistical difference were found in the the stenosis of the target vessel, hypertension, diabetes between two groups(P<0.05). The level of the S100 B protein increased after the CAS in the Symptom Changed Group and the changes had the statistical difference(P<0.05).All these showed that the patients worse original symptoms or had new symptomsafter the CAS may had a high possibility to suffer from the brain injury.Conclusion: CAS is safe and effective at the acute stage(in 2 weeks) for those patients with small cerebral infarction which were caused by unilateral carotid artery stenosis. It won’t cause increase the risk of reperfusion injury in brain. But for those patients who had worse original symptoms or had new symptoms may had a high possibility to suffer from the brain injury. Once it happens,we should pay attention to it.