• Hideo Saito, Kuniaki Ogasawara, Nobukazu Komoribayashi, Masakazu Kobayashi, Takashi Inoue, Yasunari Otawara, and Akira Ogawa.
• Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
• Neurosurgery. 2007 Jun 1;60(6):1067-73; discussion 1073-4.

ObjectiveApproximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment. The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CEA correlates with development of postoperative cognitive impairment.MethodsFifty-five patients undergoing CEA were assessed with a battery of neuropsychological tests before and 1 month after surgery. Serum samples for measurement of MDA-LDL concentration were obtained from a venous catheter inserted into the ipsilateral jugular bulb at the following time points: immediately before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA.ResultsThe MDA-LDL concentrations at 5 and 20 minutes after ICA declamping were both significantly higher than concentrations before ICA clamping (P < 0.0001). At the postoperative neuropsychological assessment, six (11%) out of 55 patients showed postoperative cognitive impairment. Logistic regression analysis demonstrated that higher values of MDA-LDL increase (calculated as a percentage of the preclamp values) at either 5 or 20 minutes after ICA declamping were significantly associated with the development of postoperative cognitive impairment (95% confidence interval, 0.787-0.981; P = 0.0209) among the variables tested.ConclusionMDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairment.

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