Ischemia Modified Albumin as A Marker of Silent Cerebral Ischemia Before and after Carotid Artery Stenting

Year 2024, Volume: 21 Issue: 3, 496 - 501

Zeynal Tunç , Emrah Aytaç

https://doi.org/10.35440/hutfd.1518649

Abstract

Background: Stroke is the second most common cause of mortality after ischemic heart disease. The aim of this study was to investigate the presence of silent ischemia in carotid stenosis wit-hout acute clinical symptoms by checking ischemia-modified albumin (IMA) level before and 14 days after stenting.
Materials and Methods: Thirty-two patients who applied to our clinic and did not have acute ischemic stroke findings were included in the study. Patients with diseases that caused an increa-se in ischemia-modified albumin levels were excluded. Samples taken from the patients before and after stenting were centrifuged and stored. All samples were studied on the same day.
Results: Thirty-two patients were included in the study. The mean age of the patients was 66.96±11.27 years. No significant difference was found in IMA levels between patients over 70 and under 70 years of age (p>0.05). It was found that the IMA level before carotid stenting (43.94±20.18) was significantly higher than the IMA level after stenting (22.00±11.34) (p<0.05).
Conclusions: This study suggests that there is a silent ischemic process in carotid stenosis even in the absence of clinical findings and that IMA can be used as a non-invasive marker of silent cereb-ral ischemia.

Keywords: Silent cerebral ischemia, carotid stenosis, carotid artery stenting, ischemia modified albumin

Keywords

Silent cerebral ischemia, carotid stenosis, carotid artery stenting, ischemia modified albumin

Sessiz Serebral İskemi Belirteci Olarak Karotis Arter Stenleme Öncesi Ve Sonrası Bakılan İskemi Modifiye Albümin

Abstract

Amaç: İnme, iskemik kalp hastalıklarından sonra mortalitenin ikinci en sık nedenidir. Bu çalışmada akut klinik bulgu vermeyen karotis darlığında stentlemeden önce ve 14 gün sonra iskemi modifiye albümin (İMA) düzeyi bakılarak sessiz iskemi varlığının araştırılması amaçlanmıştır.
Materyal ve metod: Çalışmaya kliniğimize başvuran akut iskemik inme bulguları olmayan 32 hasta alındı. İskemi modifiye albumin düzeyinde yüksekliğe yol açan hastalığı olan hastalar çalışmadan dışlandı. Çalışmaya alınan hastalardan stentlemeden önce ve sonra alınan numuneler santrifüj edilerek saklandı. Tüm numuneler aynı gün çalışıldı.
Bulgular: Çalışmaya 32 hasta alındı. Hastaların ortalama yaşı 66,96±11,27 idi. 70 yaş üzeri ve 70 yaş altı hastalar arasında İMA düzeyleri açısından anlamlı fark saptanmadı (p>0.05). Karotis stent-lemeden önce bakılan İMA düzeyinin (43,94±20,18), stentlemeden sonra bakılan İMA düzeyine (22,00±11,34) göre belirgin şekilde yüksek olduğu saptandı (p<0.05).
Sonuç: Bu çalışma karotis darlığında klinik bulgu olmadığında bile sessiz bir iskemik sürecin oldu-ğunu, İMA’nın sessiz serebral iskeminin non invaziv bir belirteci olarak kullanılabileceğini düşün-dürmektedir.

Keywords

Sessiz serebral iskemi, karotis darlığı, karotis arter stentleme, iskemi modifiye albümin

Supporting Institution

FIRAT ÜNİVERSİTESİ BAP

Thanks

Prof. Dr. Dilara Kaman' a teşekkür ederim.

References

• 1. Feigin VL, Nichols E, Alam T, Bannick MS, Beghi E, Blake N, et al. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-80.
• 2. Kan P, Mokin M, Dumont TM, Snyder KV, Siddiqui AH, Levy EI, et al. Cervical Carotid Artery Stenosis; Latest Update on Di-agnosis and Management. Curr Probl Cardiol. 2012;37(4):127-69.
• 3. Jauch EC, Lindsell C, Broderick J, Fagan SC, Tilley BC, Levine SR, et al. Association of serial biochemical markers with acu-te ischemic stroke; the National Institute of Neurological Di-sorders and Stroke recombinant tissue plasminogen activator Stroke Study. Stroke. 2006;37(10):2508-13.
• 4. Altunayoğlu ÇV, Gündüz A, Karaca Y, Alioğlu Z, Menteşe A, Topbaş M. Diagnostic Significance of Ischemia-Modified Al-bumin, S100b and Neuron-Specific Enolase in Acute Ischemic Stroke. J Acad Emerg Med. 2014;13: 112-117.
• 5. Worster A, Devereaux PJ, Heels-Ansdell D, Guyatt GH, Opie J, Mookadam F, et al. Capability of ischemia-modified albu-min to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome. CMAJ. 2005;172(13):1685-90
• 6. Erdem SS, Yerlikaya FH, Çiçekler H, Gül M. Association between ischemia-modified albumin, homocysteine, vitamin B12 and folic acid in patients with severe sepsis. Clin Chem Lab Med. 2012;50(8):1417-21.
• 7. Zurawska-Płaksej E, Grzebyk E, Marciniak D, Szymańska-Chabowska A,Piwowar A. Oxidatively modified forms of al-bumin in patients with risk factors of metabolic syndrome. J Endocrinol Invest. 2014;37(9):819-27.
• 8. Gaze DC. Ischemia modified albumin; a novel biomarker for the detection of cardiac ischemia. Drug Metab Pharmacoki-net 2009;24(4):333-41.
• 9. Sbarounı E, Georgıadou P, Kremastınos D, Voudrıs V; Ische-mia modified albumin; Is this marker of ischemia ready for prime time use? Hellenic J Cardiol. 2008;49(4):260-6.
• 10. Kleindorfer D. O, Towfighi A, Chaturvedi S., Cockroft K. M, Gutierrez J, Lombardi-Hill D, Et all. 2021 guideline for the prevention of stroke in patients with stroke and transient isc-hemic attack: a guideline from the American Heart Associa-tion/American Stroke Association. Stroke.2021;52(7):e364-e467.
• 11. Schermerhorn M. L, Liang P, Eldrup-Jorgensen J, Cronenwett J. L, Nolan B. W, Kashyap V. S, et all. Association of trans-carotid artery revascularization vs transfemoral carotid artery stenting with stroke or death among patients with carotid ar-tery stenosis. JAMA. 2019;322(23):2313-2322..
• 12. Langhoff R, Schofer J, Scheinert D, Schmidt A, Sedgewick G, Saylors E, et all. Double filtration during carotid artery sten-ting using a novel post-dilation balloon with integrated em-bolic protection. JACC: Cardiovascular Interventions 2019;12(4):395-403.
• 13. Turedi S, Gunduz A, Mentese A, Karahan SC, Yilmaz SE, Erog-lu O, et al. Value of ischemia-modified albumin in the diag-nosis of pulmonary embolism. Am J Emerg Med. 2007;25(7):770-3.
• 14. Quiles J, Roy D, Gaze D, Garrido IP, Avanzas P, Sinha M, et al. Relation of ischemia-modified albumin (IMA) levels fol-lowing elective angioplasty for stable angina pectoris to du-ration of balloon-induced myocardial ischemia. Am J Cardiol. 2003;92(3):322-4.
• 15. Zapico-Muñiz E, Santaló-Bel M, Mercé-Muntañola J, Montiel JA, Martínez-Rubio A, Ordóñez-Llanos J. Ischemia-modified albumin during skeletal muscle ischemia. Clin Chem. 2004;50(6):1063-5.
• 16. Pantazopoulos I, Papadimitriou L, Dontas I, Demestiha T, Lakovidou N, Xanthos T. Ischaemia modfied albumin in the diagnosis of acute coronary syndromes. Resuscitation. 2009;80(3):306-10.
• 17. Zinellu A, Mangoni A. A. (2024). A systematic review and meta-analysis of ischemia-modified albumin in diabetes mellitus. Heliyon. 2024;10(16):e35953..
• 18. Michalak S, Osztynowicz K, Płóciniczak A, Myszka W, Nowicki M, Węgrzyn D, et al. Ischemia-modified albumin in migraine patients during interictal period. Journal of Medical Science. 2016;85(4):231-7
• 19. Abboud H, Labreuche J, Meseguer E, Lavallee PC, Simon O, Olivot JM, et al. Ischemia-modified albumin in acute stroke. Cerebrovasc Dis. 2007;23(2-3):216-20.
• 20. Gunduz A, Turedi S, Mentese A, Altunayoglu V, Turan I, Kara-han SC, et al. Ischemia-modified albumin levels in cerebro-vascular accidents. Am J Emerg Med. 2008;26(8):874-8.
• 21. Uslu A. U, Kucuk A, Balta S, Ozturk C, Arslan S, Tekin L, et all. The relation between ischemia modified albumin levels and carotid intima media thickness in patients with rheumatoid arthritis. Int J Rheum Dis. 2019;22(1):32-37..
• 22. Altunoglu E, Guntas G, Erdenen F, Akkaya E, Topac I, Irmak H, et al. Ischemia-modified albumin and advanced oxidation protein products as potential biomarkers of protein oxidation in Alzheimer's disease. Geriatr Gerontol Int. 2015;15(7):872-80.
• 23. Can M, Varlibas F, Guven B, Akhan O, Yuksel GA. Ischemia modified albumin and plasma oxidative stress markers in Alzheimer's disease. Eur Neurol. 2013;69(6):377-80.
• 24. Zhong C, Chen T, Shen Y, Zhang Y, Liu Y, Ning L, et all. The effects of serum ischemia modified albumin on diagnosis of cerebral infarction and vertebral basilar artery stenosis. Brain Injury. 2021;35(11):1457-61.
• 25. Özsin KK, Engin M, Sanrı U. S, Toktaş F, Kahraman N, Huysal K, et all. Evaluation of the relationship between adjusted isc-hemia-modified albumin and the presence and severity of peripheral artery disease. Vascular. 2024;32(3):603-611.
• 26. Demirci B, Karakılıç M. E, Coşkun A, Yel C, Uyanık S. A, Ünal K, et all. The Brain Ischemic Volume Correlation with the Ischemic Modified Albumin Level. Bagcilar Medical Bulle-tin/Bağcılar Tıp Bülteni, 2021;6(1):26-31
• 27. Jena I, Nayak SR, Behera S, Singh B, Ray S, Jena D, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients. J Nat Sci Biol Med. 2017;8(1):110-113.
• 28. Shevtsova A, Gordiienko I, Tkachenko V, Ushakova G. Ische-mia‐modified albumin: origins and clinical implications. Dis Markers. 2021;2021:9945424.