| Therapeutic strategies for patients with internal carotid or middle cerebral artery occlusion complicated by severe coronary artery disease. | |
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MedLine Citation:
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PMID: 20849790 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND/OBJECTIVES: Ischemic stroke is one of major complications of cardiac surgery. Although a current American Heart Association (AHA) guideline states that carotid endarterectomy is probably recommended before or concomitant to coronary artery bypass grafting (CABG) for the carotid stenosis, there is no report that analyzed optimal strategies in cardiac surgery for patients with total occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA). Therefore, this preliminary study was aimed to clarify whether preoperative blood flow measurements and prophylactic superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis could reduce the incidence of perioperative ischemic stroke during cardiac surgery in patients with total occlusion of the ICA or MCA. METHODS: This prospective study included eight patients who were admitted to undergo cardiac surgery including CABG. All of them had total ICA or MCA occlusion on preoperative magnetic resonance (MR) examinations. Preoperative cerebral blood flow and its reactivity to acetazolamide were quantitatively determined in all eight patients using single photon emission computed tomography or positron emission tomography. RESULTS: Preoperative blood flow measurements revealed that two (25%) of eight patients had normal cerebral hemodynamics because of well-developed collaterals. They safely underwent cardiac surgery. However, a marked impairment of cerebral perfusion reserve was identified in six (75%) of eight patients in the ipsilateral hemispheres. Of these, four patients underwent prophylactic STA-MCA anastomosis prior to CABG. Subsequently, they safely underwent CABG without perioperative ischemic stroke. CONCLUSION: This is the first report suggesting that preoperative identification of hemodynamic compromise and prophylactic STA-MCA anastomosis may reduce perioperative ischemic stroke during cardiac surgery in patients with ICA or MCA occlusion, although further studies are needed to assess the validity. |
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Authors:
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Masahito Kawabori; Satoshi Kuroda; Shunsuke Terasaka; Naoki Nakayama; Yoshiro Matsui; Suguru Kubota; Masanori Nakamura; Katsuhiko Nakanishi; Fumiyuki Okamoto; Yoshinobu Iwasaki |
Publication Detail:
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Type: Case Reports; Evaluation Studies; Journal Article |
Journal Detail:
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Title: World neurosurgery Volume: 73 ISSN: 1878-8750 ISO Abbreviation: World Neurosurg Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-09-20 Completed Date: 2010-10-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101528275 Medline TA: World Neurosurg Country: United States |
Other Details:
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Languages: eng Pagination: 345-50 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Brain Ischemia / prevention & control, surgery Carotid Stenosis / complications, surgery* Cerebral Revascularization / methods Cerebrovascular Circulation / physiology Coronary Artery Bypass / methods Coronary Artery Disease / complications, surgery* Female Humans Iatrogenic Disease / prevention & control Infarction, Middle Cerebral Artery / complications, surgery* Intraoperative Complications / etiology, prevention & control Male Postoperative Complications / etiology, prevention & control Severity of Illness Index Treatment Outcome Vascular Surgical Procedures / adverse effects, methods*, standards |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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