| Changes in cerebrospinal fluid and blood lactate concentrations after stent-graft implantation at critical aortic segment: a preliminary study. | |
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MedLine Citation:
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PMID: 18199564 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Obstruction of blood flow through the arteria radicularis magna (ARM) has been linked with ischemic spinal cord injury after conventional thoracic aortic repair. Whether or not endoluminal stent-grafts, deliberately positioned against this artery can cause similar damage to the spinal cord has not been comprehensively investigated. The purpose of this study was to assess the blood and cerebrospinal fluid (CSF) concentrations of lactate - a well-known biochemical marker of ischemic neurological injury, before and after stent-graft implantation against the ARM. MATERIALS AND METHODS: Endoluminal stent-grafting was performed in ten mongrel dogs. In five animals (experimental group), stent-grafts covered the fourth and fifth lumbar segmental arteries - which have been described as the canine equivalents to the ARM in humans. In the remaining five animals (control group), devices of similar length were placed in the lower thoracic aorta. CSF was obtained by cisternal puncture technique at the following time points; before stent-grafting, and 15, 30 and 60 min after stent-grafting. Parallel arterial blood samples were also obtained using a heparinized syringe. All samples were centrifuged and the supernatant analysed for lactate. RESULTS: The mean preprocedural lactate concentration in the CSF was 1.7+/-0.3 mmol/l. Mean postprocedural levels in the experimental group at 15, 30 and 60 min were 3.1+/-1.9, 3.9+/-1.1 and 11.9+/-2.5 mmol/l, respectively (control values; 2.1+/-1.9, 2.7+/-1.1 and 1.9+/-1.5 mmol/l, respectively). Mean preprocedural blood lactate level was 1.8+/-0.6 mmol/l, while the mean postprocedural concentrations in the experimental group at 15, 30 and 60 min were 2.9+/-1.2, 3.4+/-1.7 and 3.9+/-2.0 mmol/l, respectively. Two out of the five animals in the experimental group suffered mild to moderate hind limb weakness. CONCLUSION: Selective placement of stent-grafts against the ARM in dogs resulted in a conspicuous increase in CSF and blood lactate concentrations 60 min after the procedure with or without physical signs of neurological deficits. Although the small sample size of this preliminary study does not allow any definitive conclusion, it may be worthwhile to confirm the findings in appropriately controlled larger studies. |
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Authors:
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Abul Hasan Muhammad Bashar; Kazuya Suzuki; Teruhisa Kazui; Mitsuo Yamaguchi Okada; Takayasu Suzuki; Naoki Washiyama; Hitoshi Terada; Katsushi Yamashita |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-01-16 |
Journal Detail:
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Title: Interactive cardiovascular and thoracic surgery Volume: 7 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-02 Completed Date: 2008-05-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101158399 Medline TA: Interact Cardiovasc Thorac Surg Country: England |
Other Details:
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Languages: eng Pagination: 262-6 Citation Subset: IM |
Affiliation:
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First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Hamamatsu City, 431-3192, Japan. ahmbashar@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Aortography Biological Markers / metabolism Blood Vessel Prosthesis* Blood Vessel Prosthesis Implantation / adverse effects*, instrumentation Dogs Female Lactic Acid / blood, cerebrospinal fluid, metabolism* Male Models, Animal Motor Activity Pilot Projects Prosthesis Design Spinal Cord Ischemia / etiology*, metabolism, physiopathology Stents* Thoracic Arteries / radiography, surgery* Time Factors Up-Regulation |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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