Abstract
Endothelin-1 (ETL-1), a peptide recently isolated from vascular endothelial cells, acts in cerebral arteries in vitro as a potent and long-lasting vasoconstrictor and has been implicated in the development of cerebral vasospasm. To ascertain whether this new vasoconstrictor has any effect on regulation of the cerebral circulation, we measured plasma ETL-1 concentrations in patients undergoing carotid revascularization and attempted to correlate the variations of venous and arterial plasma ETL-1 with the characteristics of the procedure, including cerebral vasospasm. We prospectively studied 11 patients undergoing a total of 14 carotid surgical revascularization procedures (12 endarterectomies, 2 polytetrafluoroethylene bypass grafts from the common to the internal carotid arteries). Before carotid cross-clamping, blood samples were drawn from the internal jugular vein and the healthy common carotid artery proximal to the occlusive lesion to be treated. After endarterectomy, blood samples were withdrawn from the internal, external, and common carotid arteries. After the release of the last clamp, a final aliquot of blood was withdrawn from the internal jugular vein. After plasma extraction on a C2-ethyl microcolumn, plasma endothelin-like immunoreactivity was measured by means of radioimmunoassay with a polyclonal antibody. In 9 of the 11 patients, internal jugular vein ETL-1 concentration decreased statistically significantly after carotid artery cross-clamping (4.2±1.4 pg/ml vs. 3.9±1.1 pg/ml;p<0.05). In the 2 patients in whom ETL-1 levels failed to drop, a shunt was used during the procedure in 1, and the other was the only patient who had an ipsilateral ischemic postoperative stroke. The decrease in internal jugular vein ETL-1 concentration failed to correlate with any of the cross-clamping times. The level of arterial blood ETL-1 remained steady in the common carotid artery before and after cross-clamping (4.5±1.5 pg/ml vs. 4.6±0.9 pg/ml). A small, nonsignificant decrease in ETL-1 level was noted in the external and internal carotid arteries after cross-clamping. The decrease in internal jugular vein ETL-1 levels may in part reflect a compensatory response to carotid artery cross-clamping, which could limit the reduction of local cerebral blood flow.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Yanagisawa M, Inoue A, Ishikawa T, et al. Primary structure, synthesis, and biological activity of rat endothelin, and endothelium-derived vasoconstrictor peptide. Proc Natl Acad Sci USA 1988;85:6964–6967.
Komuro I, Kurihara H, Sugiyama T, et al. Endothelin stimulates c-fos and c-myc expression and proliferation of vascular smooth muscle cells. FEBS Lett 1988;238:249–252.
Lerman A, Edwards BS, Hallett JW, et al. Circulating and tissue endothelin immunoreactivity in advanced atherosclerosis. N Engl J Med 1991;325:997–1001.
Yanagisawa M, Kurihara H, Kimura S, et al. A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature 1988;332:411–415.
Masaoka H, Suzuki R, Hirata Y, et al. Raised plasma endothelin in aneurysmal subarachnoid haemorrhage [letter]. Lancet 1989;2:1402.
Frelin C, Ladoux A, Marsault R, et al. Function of vasoactive factors in the cerebral microcirculation. J Cardiovasc Pharmacol 1992;20(Suppl 12):S94-S96.
Shigeno T, Mima T, Takakura K, et al. Effects of endothelin on cerebral arteries and its possible role in the pathogenesis of cerebral vasospasm. In Rubanyi GM, Vanhoutte PM, eds. Endothelium-derived contracting factors. Basel: Karger, 1990, pp 124–127.
Asano T, Ikegaki I, Suzuki Y, et al. Endothelin and the production of cerebral vasospasm in dogs. Biochem Biophys Res Commun 1989;159:1345–1351.
Fuxe K, Kurosawa M, Sintra A, et al. Endothelin-1 induced lesions in the brain as a new model of focal ischemia. Methods Neurosci 1991;7:256–282.
Sokolovsky M, Ambar I, Galron R. A novel subtype of endothelin receptors. J Biol Chem 1992;267:20551–20554.
Vane JR, Anggard EE, Botting RM. Mechanisms of disease: Regulatory functions of the vascular endothelium. N Engl J Med 1990;323:27–36.
Papadopoulos SM, Gilbert LL, Webb RC, et al. Characterization of contractile responses to endothelin in human cerebral arteries: Implications for cerebral vasospasm. Neurosurgery 1990;26:810–815.
Schini VB, Vanhoutte PM. Endothelin-1: A potent vasoactive peptide. Pharmacol Toxicol 1991;69:303–309.
Haynes WG, Webb DJ. Contribution of endogenous generation of endothelin-1 to basal vascular tone. Lancet 1994;344:852–854.
Onizuka M, Miyauchi T, Mitsui K, et al. Endothelin-1 mediates regional blood flow during and after pulmonary operations. J Thorac Cardiovasc Surg 1992;104:1696–1701.
Lippton HL, Hauth TA, Summer WR, et al. Endothelin produces pulmonary vasoconstriction and systemic vasodilation. J Appl Physiol 1989;66:1008–1012.
Antonucci F, Bertolissi M, Calo L. Plasma endothelin and renal function during infrarenal aortic cross clamping and nifedipine infusion [letter]. Lancet 1990;336:1449.
Hirata Y, Itoh KI, Ando K, et al. Plasma endothelin levels during surgery [letter]. N Engl J Med 1989;323:1686.
Willette RN, Ohlstein EH, Pullen M, et al. Transient forebrain ischemia alters acutely endothelin receptor density and immunoreactivity in gerbil brain. Life Sci 1993;52:35–40.
Author information
Authors and Affiliations
About this article
Cite this article
Cacoub, P., Koskas, F., Timsit, S. et al. Decrease in internal jugular endothelin levels after carotid cross-clamping during human carotid revascularization procedures. Annals of Vascular Surgery 10, 239–243 (1996). https://doi.org/10.1007/BF02001889
Issue Date:
DOI: https://doi.org/10.1007/BF02001889