Serum microtubule associated protein tau and myelin basic protein as the potential markers of brain ischaemia-reperfusion injury in patients undergoing carotid endarterectomy

Introduction. In the prevention of ischaemic stroke the recommended surgical procedure is carotid endarterectomy (CEA). However, surgical treatment of atherosclerotic stenosis may cause neurological complications. The aim of the study was to investigate consequential brain ischaemia-reperfusion injury by measuring the cerebral specific markers, the microtubule associated protein tau (MAPt) and myelin basic protein (MBP) in the serum of patients that underwent CEA. Material and methods. This study involved 25 participants who underwent CEA due to internal carotid artery stenosis. Blood samples were taken from each patient at three different intervals; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum MAPt and MBP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum MAPt and MBP levels were statistically significantly decreased 12 hours after CEA compared to the level before the surgery (p < 0.05), but MAPt and MBP levels were normalized 48 hours after CEA. There was statistically significant correlation in serum MAPt levels with the velocity of blood flow in the internal carotid artery 12 and 48 hours after CEA (p < 0.05). Conclusions. Data from our study showed that CEA affects serum neuromarkers levels, such as MAPt and MBP, in patients with significant internal carotid artery stenosis. MAPt and MBP levels showed characteristic time curve in patients who underwent CEA and did not experience any neurological deficit in perioperative period. Possible alterations of this time curve may potentially be an index of a neurological event occurrence.  Introduction. In the prevention of ischaemic stroke the recommended surgical procedure is carotid endarterectomy (CEA). However, surgical treatment of atherosclerotic stenosis may cause neurological complications. The aim of the study was to investigate consequential brain ischaemia-reperfusion injury by measuring the cerebral specific markers, the microtubule associated protein tau (MAPt) and myelin basic protein (MBP) in the serum of patients that underwent CEA. Material and methods. This study involved 25 participants who underwent CEA due to internal carotid artery stenosis. Blood samples were taken from each patient at three different intervals; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum MAPt and MBP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum MAPt and MBP levels were statistically significantly decreased 12 hours after CEA compared to the level before the surgery (p < 0.05), but MAPt and MBP levels were normalized 48 hours after CEA. There was statistically significant correlation in serum MAPt levels with the velocity of blood flow in the internal carotid artery 12 and 48 hours after CEA (p < 0.05). Conclusions. Data from our study showed that CEA affects serum neuromarkers levels, such as MAPt and MBP, in patients with significant internal carotid artery stenosis. MAPt and MBP levels showed characteristic time curve in patients who underwent CEA and did not experience any neurological deficit in perioperative period. Possible alterations of this time curve may potentially be an index of a neurological event occurrence.

Serum glial fibrillary acidic protein as a marker of brain damage in patients after carotid endarterectomy

Introduction. Surgical treatment of the extracranial section of internal carotid artery stenosis is an effective method of preventing cerebral ischaemic stroke. However, this surgical procedure may cause vascular brain damage. The aim of the study was to measure glial fibrillary acidic protein (GFAP) as a marker of brain damage in the serum of patients that underwent internal carotid endarterectomy (CEA). Material and methods. This study involved 25 participants who underwent CEA because of internal carotid artery stenosis. Blood samples were taken from each patient at three different times; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum GFAP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum GFAP levels were not statistically different between all the three measurements (p > 0.05). There was also no statistical significant difference in serum GFAP levels between symptomatic and asymptomatic patients (p > 0.05). There was no statistically significant correlation in serum GFAP level 12 and 48 hours after the surgery with the clamping time (p > 0.05). There was also no significant correlation in the serum GFAP levels with the velocity of blood flow in the internal carotid artery before CEA and after surgery (p > 0.05). Conclusions. The study revealed that CEA does not change serum GFAP levels. Thus, GFAP cannot be a biochemical marker of brain damage after this surgery

ESVM Guideline on peripheral arterial disease

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Introduction. Surgical treatment of the extracranial section of internal carotid artery stenosis is an effective method of preventing cerebral ischaemic stroke. However, this surgical procedure may cause vascular brain damage. The aim of the study was to measure glial fibrillary acidic protein (GFAP) as a marker of brain damage in the serum of patients that underwent internal carotid endarterectomy (CEA). Material and methods. This study involved 25 participants who underwent CEA because of internal carotid artery stenosis. Blood samples were taken from each patient at three different times; within 24 hours prior to surgery, 12 hours after the surgery, and 48 hours after the surgery. Serum GFAP levels were measured by a commercially available enzyme-linked immunosorbent assay (ELISA). Results. The study showed that serum GFAP levels were not statistically different between all the three measurements (p > 0.05). There was also no statistical significant difference in serum GFAP levels between symptomatic and asymptomatic patients (p > 0.05). There was no statistically significant correlation in serum GFAP level 12 and 48 hours after the surgery with the clamping time (p > 0.05). There was also no significant correlation in the serum GFAP levels with the velocity of blood flow in the internal carotid artery before CEA and after surgery (p > 0.05). Conclusions. The study revealed that CEA does not change serum GFAP levels. Thus, GFAP cannot be a biochemical marker of brain damage after this surgery

Application of endovenous mechanochemical ablation (MOCA) with Flebogrif™ to treat varicose veins of the lower extremities: a single center experience over 3 months of observation

Introduction. Chronic venous insufficiency is one of the most common medical conditions among highly developed societies. The majority of patients (70%) suffer from saphenous veins incompetency. The study presents results of a 3-month follow-up of application of venous mechanochemical ablation system with the FlebogrifTM catheter. Material and methods. The study was conducted on 200 patients, including 170 women and 30 men treated with ablation with FlebogrifTM to treat varicose veins. All patients were qualified based on the ultrasound in a standing position confirming incompetence of the great saphenous vein or small saphenous vein. The vein was punctured under ultrasound guidance in the distal part of the incompetent segment. The area of vascular access was anesthetized with 0.5 mL of 1% lignocaine. The compression therapy in the form of the first grade medical elastic stocking was used after the surgery. Results. The initial technical success of the surgery was achieved in all the patients. During the 3-month follow-up, recanalization occurred in 8 cases, in 5 patients great saphenous vein and in 3 small saphenous vein recanalised. Based on the recommendations of the European Consensus Meeting on Foam Sclerotherapy,  7 cases were defined as complete recanalization and 1 as partial. The analysis of numerical data obtained with Venous Clinical Severity Score and Clinics Ethiology Anatomy Pathophysiology Classification showed a statistically significant decrease in the severity of clinical symptoms compared to ones before the surgery and between particular days of the observation during the 3-month follow-up. Conclusions. The procedure is highly effective reaching 96% at 3 months of follow-up, provides good cosmetic effect and the low rate of complications. Minimal invasiveness of mechanochemical ablation with Flebogrif™ may improve the quality of life during the postoperative period. A long-term observation is recommended to achieve a full-value assessment of this novel method

Collagen-Sealed Polyester Vascular Prostheses Functionalized by Polycatecholamine Coatings

Collagen-sealed polyester (PET) prostheses are commonly used in reconstructive vascular surgery due to their self-sealing properties. To prevent post-surgical infection, different modification methods have been tested but so far none have showed long-term satisfactory efficiency. For this reason, in the present study, a commercial collagen-sealed PET prosthesis was coated by a highly adhesive poly (L-DOPA) layer maintaining the sealing protein without losing the original properties and functionality. This modified (as proven by SEM, FTIR, XPS and contact angle) graft exhibited comparable wettability and elasticity as pristine commercial graft, as well as reduced hemolysis-inducing effect, lowered toxicity against human endothelial cells and reduced toxicity in Danio rerio model. Poly (L-DOPA)-coated grafts were shown to bind six times more aminoglycoside antibiotic (gentamicin) than pristine graft. Poly (L-DOPA)-coated antibiotic-bound prostheses exhibited an improved antibacterial activity (bacterial growth inhibition and anti-adhesive capacity) in comparison with pristine antibiotic-bound graft. Overall, poly (L-DOPA)-coatings deposited on PET vascular grafts can effectively functionalize collagen-sealed prostheses without the loss of protein sealing layer and allow for antibiotics incorporation to provide higher safety in biomedical applications

Six-year outcomes of a phase II study of human-tissue engineered blood vessels for peripheral arterial bypass

Objective: The human acellular vessel (HAV) was evaluated for surgical bypass in a phase II study. The primary results at 24 months after implantation have been reported, and the patients will be evaluated for ≤10 years. Methods: In the present report, we have described the 6-year results of a prospective, open-label, single-treatment arm, multicenter study. Patients with advanced peripheral artery disease (PAD) requiring above-the-knee femoropopliteal bypass surgery without available autologous graft options had undergone implantation with the HAV, a bioengineered human tissue replacement blood vessel. The patients who completed the 24-month primary portion of the study will be evaluated for ≤10 years after implantation. The present mid-term analysis was performed at the 6-year milestone (72 months) for patients followed up for 24 to 72 months. Results: HAVs were implanted in 20 patients at three sites in Poland. Seven patients had discontinued the study before completing the 2-year portion of the study: four after graft occlusion had occurred and three who had died of causes deemed unrelated to the conduit, with the HAV reported as functional at their last visit. The primary results at 24 months showed primary, primary assisted, and secondary patency rates of 58%, 58%, and 74%, respectively. One vessel had developed a pseudoaneurysm deemed possibly iatrogenic; no other signs of structural failure were reported. No rejections or infections of the HAV occurred, and no patient had required amputation of the implanted limb. Of the 20 patients, 13 had completed the primary portion of the study; however, 1 patient had died shortly after 24 months. Of the remaining 12 patients, 3 died of causes unrelated to the HAV. One patient had required thrombectomy twice, with secondary patency achieved. No other interventions were recorded between 24 and 72 months. At 72 months, five patients had a patent HAV, including four patients with primary patency. For the entire study population from day 1 to month 72, the overall primary, primary assisted, and secondary patency rate estimated using Kaplan-Meier analysis was 44%, 45%, and 60% respectively, with censoring for death. No patient had experienced rejection or infection of the HAV, and no patient had required amputation of the implanted limb. Conclusions: The infection-resistant, off-the-shelf HAV could provide a durable alternative conduit in the arterial circuit setting to restore the lower extremity blood supply in patients with PAD, with remodeling into the recipient’s own vessel over time. The HAV is currently being evaluated in seven clinical trials to treat PAD, vascular trauma, and as a hemodialysis access conduit. : Clinical Relevance: Patients with peripheral artery disease who require surgical revascularization need options when autologous grafts are not available. The human acellular vessel (HAV) has been demonstrated to have characteristics similar to those of autologous vessels in terms of resistance to infection, mechanics, and a very low risk of rejection. Safety and performance were evaluated for ≤6 years after implantation of an HAV in a femoropopliteal position. Overall, the secondary patency rate estimated using the Kaplan-Meier method was 60% at 72 months, with 45% primary patency. No infection or rejection episodes had occurred with the HAV conduits. These data have demonstrated the durability of the HAV and suggest the occurrence of cellular remodeling by the host