Biochemical parameters of cerebral lesions in carotid artery surgery (literature review)

Currently, biochemical markers occupy an important position in diagnosis and treatment of a series of diseases and conditions such as myocardial infarction (troponines I and T), oncological diseases (prostate-specific antigen, carcinoembryonic antigen, and others) etc. Brain damage markers have long been investigated in patients with endured strokes, transitory ischemic attacks, as well as with a history of dyscirculatory lesions of the brain and other cerebral diseases. For patients after surgical interventions on the carotid basin, there are no precisely developed markers of controlling the lesion at the serological level, thus making it necessary to consider possible parameters to assess brain damage. This article reviews the Russian and foreign literature dedicated to biochemical markers of cerebral tissue lesions associated with interventions on carotid arteries, providing general characteristics of the parameters regarded as factors related to cerebral cell lesions, and selecting those more suitable for assessment of namely cerebral damage, such as neuron-specific enolase (NSE), protein S-100B, brain-derived neurotrophic factor (BDNF). Markers associated with vascular damage or inflammation should be regarded only in conjunction with main proteins of cerebral lesion or neurovisualization. It should be underlined that there are no markers with 100% specificity to nervous tissue damage, and any of the represented indicators may be higher than reference values in one or another condition or disease. This is followed by describing various clinical situations of their application, such as the use of a temporary shunt in carotid endarterectomy, assessment of postoperative neurological deficit, cerebral hyperperfusion syndrome, intraoperative control, comparing their alterations during stenting of carotid arteries and carotid endarterectomy. Also discussed are possibilities of their use for diagnosis of various changes in the neurological status of patients in the early and remote postoperative period, relationship of these markers with various types and techniques of interventions on carotid arteries. A conclusion was drawn regarding their use in clinical practice.