open access

Vol 27, No 4 (2021)
Research paper
Published online: 2022-01-28
Get Citation

Biomarkers of brain ischemia-reperfusion injury after carotid endarterectomy

DOI: 10.5603/AA.2021.0013
·
Acta Angiologica 2021;27(4):113-119.
Affiliations
  1. Chair and Department of Vascular Surgery and Angiology, Medical University of Lublin, Poland, Staszica 11, 20-081 Lublin, Poland
  2. Chair and Department of Biology and Genetics, Medical University of Lublin, Poland, Lublin, Poland
  3. University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma, USA, Oklahoma City, United States
  4. Department of Neurology, Neurological and Psyhiatric Nursing, Medical University of Lublin

open access

Vol 27, No 4 (2021)
-- For assignment --
Published online: 2022-01-28

Abstract

Abstract Background: Endarterectomy of the internal carotid artery (CEA) is a surgical procedure used to prevent cerebral ischemic stroke. Available data from previous literature indicates that CEA may lead to complications in the form of cerebral ischemia-reperfusion syndrome and oxidative stress. The aim of this study was to evaluate the serum levels of oxidative stress-related biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) in patients who underwent CEA. Material and methods. Twenty-four patients with severe internal carotid artery stenosis participated in the study. Serum samples were taken from patients at three different times: within 24 hours preoperatively to CEA, 12 hours postoperatively, and 48 hours postoperatively. Serum 8-OHdG and MDA levels were measured using a commercially available enzyme-linked immunosorbent assay. Results: Serum 8-OHdG levels indicated statistically significant elevation 12 hours after surgery when compared to preoperative levels (p<0.05). A further increase in the concentration of this parameter was observed 48 hours after surgery when compared to the previous measurement, however, this increase was no longer statistically significant (p=0.05). Furthermore, serum MDA levels also indicated a statistically significantly elevation 48 hours after surgery when compared to preoperative levels (p<0.05). Conclusion: Our study showed that CEA causes an increase in blood levels of 8-OHdG and MDA, which may be related to the occurrence of oxidative stress during cerebral ischemia-reperfusion injury. Therefore, 8-OHdG and MDA may represent corresponding markers of cerebral ischemia-reperfusion complications in patients undergoing CEA.

Abstract

Abstract Background: Endarterectomy of the internal carotid artery (CEA) is a surgical procedure used to prevent cerebral ischemic stroke. Available data from previous literature indicates that CEA may lead to complications in the form of cerebral ischemia-reperfusion syndrome and oxidative stress. The aim of this study was to evaluate the serum levels of oxidative stress-related biomarkers such as 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) in patients who underwent CEA. Material and methods. Twenty-four patients with severe internal carotid artery stenosis participated in the study. Serum samples were taken from patients at three different times: within 24 hours preoperatively to CEA, 12 hours postoperatively, and 48 hours postoperatively. Serum 8-OHdG and MDA levels were measured using a commercially available enzyme-linked immunosorbent assay. Results: Serum 8-OHdG levels indicated statistically significant elevation 12 hours after surgery when compared to preoperative levels (p<0.05). A further increase in the concentration of this parameter was observed 48 hours after surgery when compared to the previous measurement, however, this increase was no longer statistically significant (p=0.05). Furthermore, serum MDA levels also indicated a statistically significantly elevation 48 hours after surgery when compared to preoperative levels (p<0.05). Conclusion: Our study showed that CEA causes an increase in blood levels of 8-OHdG and MDA, which may be related to the occurrence of oxidative stress during cerebral ischemia-reperfusion injury. Therefore, 8-OHdG and MDA may represent corresponding markers of cerebral ischemia-reperfusion complications in patients undergoing CEA.

Get Citation

Keywords

Keywords: brain ischemia-reperfusion injury, carotid endarterectomy, 8-hydroxydeoxyguanosine, malondialdehyde, oxidative stress biomarkers

About this article
Title

Biomarkers of brain ischemia-reperfusion injury after carotid endarterectomy

Journal

Acta Angiologica

Issue

Vol 27, No 4 (2021)

Article type

Research paper

Pages

113-119

Published online

2022-01-28

Page views

1157

Article views/downloads

134

DOI

10.5603/AA.2021.0013

Bibliographic record

Acta Angiologica 2021;27(4):113-119.

Keywords

Keywords: brain ischemia-reperfusion injury
carotid endarterectomy
8-hydroxydeoxyguanosine
malondialdehyde
oxidative stress biomarkers

References (40)
  1. Brinster CJ, Sternbergh WC. Safety of urgent carotid endarterectomy following thrombolysis. J Cardiovasc Surg (Torino). 2020; 61(2): 149–158.
  2. Khattar NK, Friedlander RM, Chaer RA, et al. Perioperative stroke after carotid endarterectomy: etiology and implications. Acta Neurochir (Wien). 2016; 158(12): 2377–2383.
  3. Reddy RP, Karnati T, Massa RE, et al. Association between perioperative stroke and 30-day mortality in carotid endarterectomy: A meta-analysis. Clin Neurol Neurosurg. 2019; 181: 44–51.
  4. Hitchner E, Baughman BD, Soman S, et al. Microembolization is associated with transient cognitive decline in patients undergoing carotid interventions. J Vasc Surg. 2016; 64(6): 1719–1725.
  5. Zhou W, Baughman BD, Soman S, et al. Volume of subclinical embolic infarct correlates to long-term cognitive changes after carotid revascularization. J Vasc Surg. 2017; 65(3): 686–694.
  6. Kirchoff-Torres KF, Bakradze E. Cerebral Hyperperfusion Syndrome After Carotid Revascularization and Acute Ischemic Stroke. Curr Pain Headache Rep. 2018; 22(4): 24.
  7. Shoskes A, Mullaguri N, Purohit M, et al. Ipsilateral Reversible Cerebral Vasculopathy Secondary to Carotid Artery Revascularization: A Case Report. Neurohospitalist. 2021; 11(2): 165–169.
  8. Galyfos G, Sianou A, Filis K. Cerebral hyperperfusion syndrome and intracranial hemorrhage after carotid endarterectomy or carotid stenting: A meta-analysis. J Neurol Sci. 2017; 381: 74–82.
  9. Abreu P, Nogueira J, Rodrigues FB, et al. Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis. Acta Neurochir (Wien). 2017; 159(11): 2089–2097.
  10. Sun K, Fan J, Han J. Ameliorating effects of traditional Chinese medicine preparation, Chinese materia medica and active compounds on ischemia/reperfusion-induced cerebral microcirculatory disturbances and neuron damage. Acta Pharm Sin B. 2015; 5(1): 8–24.
  11. Yeh TT, Hsieh YW, Wu CY, et al. The reliability and predictive ability of a biomarker of oxidative DNA damage on functional outcomes after stroke rehabilitation. Int J Mol Sci. 2014; 15(4): 6504–6516.
  12. Vendrov AE, Vendrov KC, Smith A, et al. Oxidative stress and vascular disease. Arterioscler Thromb Vasc Biol. 2005; 25(1): 29–38.
  13. Chamorro A. Role of inflammation in stroke and atherothrombosis. Cerebrovasc Dis. 2004; 17 Suppl 3: 1–5.
  14. Nakajima H, Unoda KI, Ito T, et al. The Relation of Urinary 8-OHdG, A Marker of Oxidative Stress to DNA, and Clinical Outcomes for Ischemic Stroke. Open Neurol J. 2012; 6: 51–57.
  15. Canugovi C, Misiak M, Ferrarelli LK, et al. The role of DNA repair in brain related disease pathology. DNA Repair (Amst). 2013; 12(8): 578–587.
  16. Takemori K, Murakami T, Kometani T, et al. Possible involvement of oxidative stress as a causative factor in blood-brain barrier dysfunction in stroke-prone spontaneously hypertensive rats. Microvasc Res. 2013; 90: 169–172.
  17. Radi E, Formichi P, Battisti C, et al. Apoptosis and oxidative stress in neurodegenerative diseases. J Alzheimers Dis. 2014; 42 Suppl 3: S125–S152.
  18. Xiang F, Shuanglun X, Jingfeng W, et al. Association of serum 8-hydroxy-2'-deoxyguanosine levels with the presence and severity of coronary artery disease. Coron Artery Dis. 2011; 22(4): 223–227.
  19. Liu H, Uno M, Kitazato KT, et al. Peripheral oxidative biomarkers constitute a valuable indicator of the severity of oxidative brain damage in acute cerebral infarction. Brain Res. 2004; 1025(1-2): 43–50.
  20. Tsikas D. Assessment of lipid peroxidation by measuring malondialdehyde (MDA) and relatives in biological samples: Analytical and biological challenges. Anal Biochem. 2017; 524: 13–30.
  21. Lorente L, Martín MM, Abreu-González P, et al. Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality. PLoS One. 2015; 10(5): e0125893–3277.
  22. Liapis CD, Bell PRF, Mikhailidis D, et al. ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009; 37(4 Suppl): 1–19.
  23. Staikov IN, Arnold M, Mattle HP, et al. Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. European Carotid Surgery Trial. North American Symptomatic Carotid Endarterectomy Trial. J Neurol. 2000; 247(9): 681–686.
  24. Obradovic M, Zafirovic S, Essack M, et al. Antioxidant enzymes expression in lymphocytes of patients undergoing carotid endarterectomy. Med Hypotheses. 2020; 134: 109419.
  25. Lorente L, Martín MM, González-Rivero AF, et al. DNA and RNA oxidative damage are associated to mortality in patients with cerebral infarction. Med Intensiva (Engl Ed). 2021; 45(1): 35–41.
  26. Liu Z, Cai Y, He J. High serum levels of 8-OHdG are an independent predictor of post-stroke depression in Chinese stroke survivors. Neuropsychiatr Dis Treat. 2018; 14: 587–596.
  27. Zhao Y, Huang G, Chen S, et al. Folic acid deficiency increases brain cell injury via autophagy enhancement after focal cerebral ischemia. J Nutr Biochem. 2016; 38: 41–49.
  28. Suga Y, Ogasawara K, Saito H, et al. Preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy correlate with development of postoperative cerebral hyperperfusion. Stroke. 2007; 38(10): 2712–2717.
  29. Saito H, Ogasawara K, Komoribayashi N, et al. Concentration of malondialdehyde-modified low-density lipoprotein in the jugular bulb during carotid endarterectomy correlates with development of postoperative cognitive impairment. Neurosurgery. 2007; 60(6): 1067–73; discussion 1073.
  30. Shaafi S, Hadisi F, Mahmoudinezhad M, et al. The significance of the oxidative stress markers in the one-year prognosis of patients with acute ischemic stroke: a case-control study. BMC Neurol. 2021; 21(1): 258.
  31. Cojocaru IM, Cojocaru M, Sapira V, et al. Evaluation of oxidative stress in patients with acute ischemic stroke. Rom J Intern Med. 2013; 51(2): 97–106.
  32. Jena I, Nayak SR, Behera S, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients. J Nat Sci Biol Med. 2017; 8(1): 110–113.
  33. Milanlioglu A, Aslan M, Ozkol H, et al. Serum antioxidant enzymes activities and oxidative stress levels in patients with acute ischemic stroke: influence on neurological status and outcome. Wien Klin Wochenschr. 2016; 128(5-6): 169–174.
  34. Menon B, Ramalingam K, Kumar R. Evaluating the Role of Oxidative Stress in Acute Ischemic Stroke. J Neurosci Rural Pract. 2020; 11(1): 156–159.
  35. Kotur-Stevuljevic J, Bogavac-Stanojevic N, Jelic-Ivanovic Z, et al. Oxidative stress and paraoxonase 1 status in acute ischemic stroke patients. Atherosclerosis. 2015; 241(1): 192–198.
  36. Zhou F, Wang M, Ju J, et al. Schizandrin A protects against cerebral ischemia-reperfusion injury by suppressing inflammation and oxidative stress and regulating the AMPK/Nrf2 pathway regulation. Am J Transl Res. 2019; 11(1): 199–209.
  37. Guo C, Wang S, Duan J, et al. Protocatechualdehyde Protects Against Cerebral Ischemia-Reperfusion-Induced Oxidative Injury Via Protein Kinase Cε/Nrf2/HO-1 Pathway. Mol Neurobiol. 2017; 54(2): 833–845.
  38. Suda S, Katsura Ki, Kanamaru T, et al. Valproic acid attenuates ischemia-reperfusion injury in the rat brain through inhibition of oxidative stress and inflammation. Eur J Pharmacol. 2013; 707(1-3): 26–31.
  39. Nagatani K, Wada K, Takeuchi S, et al. Effect of hydrogen gas on the survival rate of mice following global cerebral ischemia. Shock. 2012; 37(6): 645–652.
  40. Kalimeris K, Kouni S, Kostopanagiotou G, et al. Cognitive function and oxidative stress after carotid endarterectomy: comparison of propofol to sevoflurane anesthesia. J Cardiothorac Vasc Anesth. 2013; 27(6): 1246–1252.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl