Cerebrovascular disease and perioperative neurologic vulnerability: A prospective cohort study

Phillip E. Vlisides, Bryan Kunkler, Aleda Thompson, Mackenzie Zierau, Remy Lobo, Mary O. Strasser, Michael J. Cantley, Amy McKinney, Allen D Everett, George A. Mashour, Paul Picton

Research output: Contribution to journalArticle

Abstract

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 noncardiac surgery patients. 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. 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. 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.

Original languageEnglish (US)
Article number560
JournalFrontiers in Neurology
Volume10
Issue numberMAY
DOIs
StatePublished - Jan 1 2019

Fingerprint

Cerebrovascular Disorders
Nervous System
Cohort Studies
Oximetry
Prospective Studies
Biomarkers
Perioperative Period
Phosphopyruvate Hydratase
Glial Fibrillary Acidic Protein
Matrix Metalloproteinase 9
Wounds and Injuries
Serum
Cognition
Stroke
Research

Keywords

  • Biomarkers
  • Cerebrovascular disease
  • Cognitive dysfunction
  • Hypoxia-ischemia
  • Perioperative care
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Vlisides, P. E., Kunkler, B., Thompson, A., Zierau, M., Lobo, R., Strasser, M. O., ... Picton, P. (2019). Cerebrovascular disease and perioperative neurologic vulnerability: A prospective cohort study. Frontiers in Neurology, 10(MAY), [560]. https://doi.org/10.3389/fneur.2019.00560

Cerebrovascular disease and perioperative neurologic vulnerability : A prospective cohort study. / Vlisides, Phillip E.; Kunkler, Bryan; Thompson, Aleda; Zierau, Mackenzie; Lobo, Remy; Strasser, Mary O.; Cantley, Michael J.; McKinney, Amy; Everett, Allen D; Mashour, George A.; Picton, Paul.

In: Frontiers in Neurology, Vol. 10, No. MAY, 560, 01.01.2019.

Research output: Contribution to journalArticle

Vlisides, PE, Kunkler, B, Thompson, A, Zierau, M, Lobo, R, Strasser, MO, Cantley, MJ, McKinney, A, Everett, AD, Mashour, GA & Picton, P 2019, 'Cerebrovascular disease and perioperative neurologic vulnerability: A prospective cohort study', Frontiers in Neurology, vol. 10, no. MAY, 560. https://doi.org/10.3389/fneur.2019.00560
Vlisides, Phillip E. ; Kunkler, Bryan ; Thompson, Aleda ; Zierau, Mackenzie ; Lobo, Remy ; Strasser, Mary O. ; Cantley, Michael J. ; McKinney, Amy ; Everett, Allen D ; Mashour, George A. ; Picton, Paul. / Cerebrovascular disease and perioperative neurologic vulnerability : A prospective cohort study. In: Frontiers in Neurology. 2019 ; Vol. 10, No. MAY.
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abstract = "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 noncardiac surgery patients. 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. 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. 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.",
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AU - Kunkler, Bryan

AU - Thompson, Aleda

AU - Zierau, Mackenzie

AU - Lobo, Remy

AU - Strasser, Mary O.

AU - Cantley, Michael J.

AU - McKinney, Amy

AU - Everett, Allen D

AU - Mashour, George A.

AU - Picton, Paul

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N2 - 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 noncardiac surgery patients. 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. 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. 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.

AB - 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 noncardiac surgery patients. 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. 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. 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.

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KW - Cognitive dysfunction

KW - Hypoxia-ischemia

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