Ischemia modified albumin before and after carotis artery stenting AS A marker of quiet cerebral ischemia

ABSTRACT ISCHEMIA MODIFIED ALBUMIN BEFORE AND AFTER CAROTIS ARTERY STENTING AS A MARKER OF QUIET CEREBRAL ISCHEMIA According to ministry of health 2010 datas, stroke is the second most common cause of mortality after ischemic heart disease in our country. The most common cause of disability is stroke. The estimated stroke prevalence increases with age. Approximately 0,5 % of patients aged 60-79 have significant stenosis of carotid artery, and approximately 10 % of patients over 80 years of age have significant stenosis. Craniocervical atherosclerosis is the cause of about 20-25 % of all ischemic stroke cases. If the asymptomatic carotid artery stenosis is below 75 %, annual stroke risk is 1,3 %, stenosis is above 75 % annual stroke and transient ischemic attack (TIA) risk is 10,5 %. In this study, it was aimed to investigate the level of ischemia-modified albumin (IMA before and 14 days after stenting to show presence of silent ischemia in the carotid artery stenosis which does not give clinical findings. Patients who did not have acute stroke findings were referred to our clinic studied. Patients with high IMA levels such as ischemic heart disease, pulmonary embolism, skeletal ischemia and advanced renal failure were excluded. Blood of the studied patients (n = 32) was centrifuged and stored at -20 °C, within 24 hours before and 14 days after carotid artery stenting. All samples were run on the same day. The IMA level before carotid stenting was significantly higher than the IMA level after stenting (p<0.0001). There was no correlation between the grade of carotid stenosis, age, sex, and accompanying disease variables and IMA sequence. Doppler ultrasonography, contrast enhanced computerized tomography angiogram (BTA), contrast magnetic resonance angiogram (MRA) and digital subtraction angiography are used in the diagnosis of carotid stenosis. This study suggests that IMA can be used as a simple, inexpensive and noninvasive screening test for carotid stenosis or by correlating dopler ultrasonography. It is also thought that IMA may also correlate with impairment of perfusion. In conclusion, this study suggests that there is a silent ischemic process even if no clinical evidence of carotid stenosis and IMA can be used as a non-invasive marker of silent cerebral ischemia. Key words; Quiet cerebral ischemia, carotid stenosis, carotid artery stenting, ischemia modified albumin