Document Detail

Intentional hypertension during dissection of carotid arteries in endarterectomy prevents postoperative development of new cerebral ischemic lesions due to intraoperative microemboli.
MedLine Citation:
PMID:  21415798     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Low blood flow velocity in the middle cerebral artery (MCA) correlates with the development of postoperative cerebral ischemic lesions related to generation of microemboli during dissection of carotid arteries in carotid endarterectomy (CEA). OBJECTIVE:: The purpose of this prospectively controlled trial was to determine whether increased mean blood flow velocity (MFV) in the MCA by intentional hypertension during carotid dissection in CEA prevented postoperative development of new cerebral ischemic lesions due to intraoperative microemboli. METHODS:: Patients with ipsilateral internal carotid artery stenosis (>70%) underwent carotid endarterectomy (CEA) under transcranial Doppler monitoring of MFV and microembolic signals (MES) in the ipsilateral MCA. Attempts were made to keep systolic blood pressure during carotid dissection between -10% and +10% of the preoperative value (controls, n=65) or above a +10% increase (intentional hypertension group, n=65). RESULTS:: Incidence of new ischemic lesions on postoperative diffusion-weighted magnetic resonance imaging (DWI) was significantly lower in the intentional hypertension group both for all patients (controls, 15.4%; intentional hypertension group, 3.1%; P=0.0302) and in a subgroup of 37 patients showing MES during carotid dissection (controls, 52.6%; intentional hypertension group, 11.1%; P=0.0128). Logistic regression analysis demonstrated absence of intentional hyperperfusion (95% confidence interval (CI), 1.77-100.00; P=0.0119) and high number of MES (95%CI, 1.00-1.62; P=0.0496) during carotid dissection were significant independent predictors of the postoperative development of new ischemic lesions on DWI. CONCLUSION:: Increased MCA MFV by intentional hypertension during dissection of the carotid artery in CEA prevents postoperative development of new cerebral ischemic lesions due to intraoperative microemboli.
Masakazu Kobayashi; Kuniaki Ogasawara; Kenji Yoshida; Makoto Sasaki; Hiroki Kuroda; Taro Suzuki; Yoshitaka Kubo; Shunrou Fujiwara; Akira Ogawa
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-15
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery (M.K., K.O., K.Y., H.K., T.S., Y.K., SF) and Advanced Research Center (M.S.), Iwate Medical University, Morioka, Japan.
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