phosphocreatine and Carotid-Stenosis

BACKGROUND The relative efficacy of carotid endarterectomy (CEA)/thromboendarterectomy (TEA) and carotid artery stenting (CAS) already has been compared in randomized controlled trials and a meta-analysis, but only limited data exist describing the status of cerebral metabolism before and after these interventions. The aim of the present study was to compare metabolic changes before and after treatment of carotid stenosis and assess their potential clinical implications.   MATERIAL AND METHODS Patients with asymptomatic unilateral critical internal CAS were imaged with proton 3T magnetic resonance spectroscopy (H-MRS) because the technique is more sensitive than regular magnetic resonance imaging for detection of the early signs of ischemic events. Abnormal metabolite ratios detected with H-MRS may precede actual morphological changes associated with hypoperfusion as well as reperfusion changes. Ipsilateral and contralateral middle cerebral artery vascular territories were both evaluated before and after vascular intervention. H-MRS was performed within 24 h before and after surgery. Correlations in the metabolic data from H-MRS for N-acetylaspartic acid (NAA)+N-acetylaspartylglutamate, creatinine (Cr)+phosphocreatinine, and phosphocholine+glycerophosphocholine (Cho) were sought. RESULTS H-MRS voxels from 11 subjects were analyzed. Values for dCho/CrI, dCho/CrC and Cho/Naal (P<0.001) were significantly higher ipsilaterally than contralaterally. Ratios for dNaa/ChoC and Cho/NaaC were significantly higher on the non-operated side (P<0.001). CONCLUSIONS H-MRS may be helpful for assessment of patients with CAS, particularly because unlike other modalities, it reveals postoperative changes in metabolic brain status. Initial results indicate the important role of perioperative neuroprotective treatment.

Topics: Aged; Aged, 80 and over; Aspartic Acid; Brain; Carotid Artery, Internal; Carotid Stenosis; Creatinine; Dipeptides; Endarterectomy, Carotid; Female; Glycerylphosphorylcholine; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Metabolome; Middle Aged; Middle Cerebral Artery; Phosphocreatine; Phosphorylcholine; Prospective Studies; Stents

Clinical effectiveness of metabolic support in surgical treatment of patients, suffering stenotic affection of carotid arteries, was estimated. Neoton intraoperative injection inside internal carotid artery have promoted improvement of metabolism in ischemized brain tissues, reduction of metabolic acidosis severity, and preservation of normal bioelectrical activity of the brain. Expediency of prolongation of clinical investigation for intraoperative prophylaxis of reperfusional brain tissue damage, while surgical treatment of patients, suffering stenotic affection of carotid arteries, using metabolic support, was discussed.

Topics: Acidosis; Brain; Brain Ischemia; Cardiotonic Agents; Carotid Artery, Internal; Carotid Stenosis; Catheters, Indwelling; Electroencephalography; Endarterectomy, Carotid; Female; Humans; Lactic Acid; Male; Middle Aged; Phosphocreatine

An animal model involving stepwise occlusion of the common carotid arteries (sCCAO) in DBA/2 mice is presented in which the right and left carotid arteries were permanently ligated within a time interval of four weeks. Thereafter, cerebral functional and structural parameters were determined at acute (15 min) and subchronic (1 day; 3, 7, and 14 days) time points after sCCAO. Quantitative changes in regional cerebral blood flow (rCBF) as determined by the [14C]iodoantipyrine method, energy state (ATP, phosphocreatine, ADP, AMP, adenosine) as shown by HPLC, brain histopathology, and neuronal densities were measured in both hemispheres. Acute sCCAO was accompanied by a drastic reduction in cerebral energy-rich phosphate concentrations, ATP and phosphocreatine, and in rCBF of more than 50%. In contrast, cortical adenosine increased around five-fold. Subchronic sCCAO, however, was associated with normalization in brain energy metabolites and near-complete restoration of rCBF, except in the caudate nucleus (-40%). No marked signs of necrotic or apoptotic cell destruction were detected. Thus, during the subchronic period, compensatory mechanisms are induced to counteract the drastic changes seen after acute vessel occlusion. In conclusion, this sCCAO mouse model may be useful for long-lasting investigations of stepwise deterioration contributing to chronic cerebrovascular disorders.

Topics: Adenosine; Adenosine Triphosphate; Animals; Biomarkers; Brain Ischemia; Carotid Stenosis; Cerebral Cortex; Cerebrovascular Circulation; Disease Models, Animal; Down-Regulation; Energy Metabolism; Female; Mice; Mice, Inbred DBA; Nerve Degeneration; Neurons; Oxidative Phosphorylation; Phosphocreatine; Up-Regulation