10.3389/fneur.2019.00560.s001 Phillip E. Vlisides Phillip E. Vlisides Bryan Kunkler Bryan Kunkler Aleda Thompson Aleda Thompson Mackenzie Zierau Mackenzie Zierau Remy Lobo Remy Lobo Mary O. Strasser Mary O. Strasser Michael J. Cantley Michael J. Cantley Amy McKinney Amy McKinney Allen D. Everett Allen D. Everett George A. Mashour George A. Mashour Paul Picton Paul Picton Image_1_Cerebrovascular Disease and Perioperative Neurologic Vulnerability: A Prospective Cohort Study.pdf Frontiers 2019 biomarkers cerebrovascular disease cognitive dysfunction hypoxia-ischemia perioperative care stroke 2019-05-28 04:10:39 Figure https://frontiersin.figshare.com/articles/figure/Image_1_Cerebrovascular_Disease_and_Perioperative_Neurologic_Vulnerability_A_Prospective_Cohort_Study_pdf/8188883 <p>Background: Stroke is a devastating perioperative complication without effective methods for prevention or diagnosis. The objective of this study was to analyze evidence-based strategies for detecting cerebrovascular vulnerability and injury in a high-risk cohort of non-cardiac surgery patients.</p><p>Methods: This was a single-center, prospective cohort study. Fifty patients undergoing non-cardiac surgery were recruited −25 with known cerebrovascular disease and 25 matched controls. Neurologic vulnerability was measured with intraoperative cerebral oximetry as the primary outcome. Perioperative neurocognitive testing and serum biomarker analysis (S-100β, neuron specific enolase, glial fibrillary acid protein, and matrix metalloproteinase-9) were measured as secondary outcomes.</p><p>Results: Cerebral desaturation events (an oximetry decrease ≥20% from baseline or <50% absolute value for ≥3 min) occurred in 7/24 (29%) cerebrovascular disease patients and 2/24 (8.3%) controls (relative risk 3.5, 95% CI 0.81–15.2; P = 0.094). Cognitive function trends were similar in both groups, though overall scores (range: 1,500–7,197) were ~1 standard deviation lower in cerebrovascular patients across the entire perioperative period (−1,049 [95% CI −1,662, −436], P < 0.001). No significant serum biomarker differences were found between groups over time. One control patient experienced intraoperative hypoxic-ischemic injury, but no robust biomarker or oximetry changes were observed.</p><p>Conclusions: Cerebrovascular disease patients did not demonstrate dramatic differences in cerebral oximetry, cognitive trajectory, or molecular biomarkers compared to controls. Moreover, a catastrophic hypoxic-ischemic event was neither predicted nor detected by any strategy tested. These findings support the need for novel research into cerebrovascular risk and vulnerability.</p>