Summary
Background. Previous studies have demonstrated that elevated pre-operative monocyte count is an independent predictor of acute neurocognitive decline following carotid endarterectomy (CEA). Monocyte chemoattractant protein-1 (MCP-1), secreted by human endothelial and monocyte-like cells, is a potent mediator of inflammation and mononuclear cell trafficking. This study examines the relationship between peri-operative serum MCP-1 elevation and post-operative neurocognitive injury following CEA.
Methods. Fifty-two patients undergoing CEA and 67 lumbar laminectomy (LL) controls were administered a battery of five neuropsychological tests pre-operatively and on post-operative day 1 (POD 1). Change in individual test scores from baseline to POD 1 were converted into Z-score and used to develop a point system quantifying the degree of neurocognitive dysfunction relative to change within the LL group. Neurocognitive injury following CEA was defined as a score greater than 2 standard deviations above mean total deficit scores of LL controls. Serum MCP-1 levels were measured pre-operatively and on POD 1 by enzyme-linked immunosorbent assay.
Findings. Mean percent MCP-1 elevation was higher for the 13 injured CEA patients (147.7 ± 32.4%) in our cohort compared to 39 age- and sex-matched uninjured CEA patients (76.0 ± 16.5%). In unconditional multivariate logistic regression analysis, percent elevation in serum MCP-1 level was associated with neurocognitive injury one day after CEA (OR = 2.19, 95% CI = 1.13–4.26, P = 0.021, for a 100% elevation from pre-operative levels).
Conclusions. Peri-operative elevations in serum MCP-1 levels correlate with acute neurocognitive dysfunction following CEA. These data implicate an inflammatory mechanism in the pathogenesis of Ischaemic neurocognitive decline.
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Abbreviations
- MCP:
-
monocyte chemoattractant protein-1
- CEA:
-
carotid endarterectomy
- DWI:
-
diffusion weighted imaging
- LL:
-
lumbar laminectomy
- POD:
-
postoperative day
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Correspondence: Ricardo J. Komotar MD, Department of Neurosurgery, Columbia University, 710 West 168th Street, Room 431, New York, NY 10032, USA.
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Mack, W., Ducruet, A., Hickman, Z. et al. Elevation of monocyte chemoattractant protein-1 in patients experiencing neurocognitive decline following carotid endarterectomy. Acta Neurochir (Wien) 150, 779–784 (2008). https://doi.org/10.1007/s00701-008-1618-6
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DOI: https://doi.org/10.1007/s00701-008-1618-6