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Selective cerebral perfusion

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https://www.readbyqxmd.com/read/28718260/cerebral-oximetry-use-for-cardiac-surgery
#1
Syed Shahmeer Raza, Farhan Ullah, Chandni, Edward Bruce Savage
BACKGROUND: Studies have shown maintaining good cerebral perfusion during Cardiac Surgeries is very important in terms of patient outcomes and reducing the hospital stay, which may have its financial and clinical implications. The aim of this review study was to determine the effectiveness of Cerebral Oximetry (Transcranial Near-Infrared Spectroscopy-NIRS to monitor cerebral oxygenation) for Cardiac Surgery and to propose a possible concluding remark about its potential applications, overall clinical value and whether to keep using it or not...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28709662/neonatal-aortic-arch-reconstruction-with-direct-splanchnic-perfusion-avoids-deep-hypothermia
#2
Muhammad Aanish Raees, Clinton D Morgan, Venessa L Pinto, Ashly C Westrick, Chevis N Shannon, Karla G Christian, Bret A Mettler, David P Bichell
BACKGROUND: Neonatal aortic arch reconstruction, typically performed with deep hypothermia and selective cerebral perfusion, leaves splanchnic organ protection dependent on hypothermia alone. A simplified method of direct in-field descending aortic perfusion during neonatal arch reconstruction permits the avoidance of deep hypothermia. We hypothesize that direct splanchnic perfusion at mild hypothermia provides improved or equivalent safety compared with deep hypothermia and may contribute to postoperative extracardiac organ recovery...
July 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28672909/feasibility-of-dual-low-scheme-combined-with-iterative-reconstruction-technique-in-acute-cerebral-infarction-volume-ct-whole-brain-perfusion-imaging
#3
Tao Wang, Yi Gong, Yibing Shi, Rong Hua, Qingshan Zhang
The feasibility of application of low-concentration contrast agent and low tube voltage combined with iterative reconstruction in whole brain computed tomography perfusion (CTP) imaging of patients with acute cerebral infarction was investigated. Fifty-nine patients who underwent whole brain CTP examination and diagnosed with acute cerebral infarction from September 2014 to March 2016 were selected. Patients were randomly divided into groups A and B. There were 28 cases in group A [tube voltage, 100 kV; contrast agent, iohexol (350 mg I/ml), reconstructed by filtered back projection] and 31 cases in group B [tube voltage, 80 kV; contrast agent, iodixanol (270 mg I/ml), reconstructed by algebraic reconstruction technique]...
July 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28671863/rethinking-the-paradigm-modern-approach-to-proximal-aortic-reconstruction-demonstrates-excellent-outcomes
#4
Jonathan M Hemli, Edward R R DeLaney, Kush R Dholakia, Dror Perk, Nirav C Patel, S Jacob Scheinerman, Derek R Brinster
BACKGROUND: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution. METHODS: The majority of our patients were male, mean age 61...
June 20, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28671861/the-transcranial-doppler-sonography-for-optimal-monitoring-and-optimization-of-cerebral-perfusion-in-aortic-arch-surgery-a-case-series
#5
Tamer Ghazy, Ayham Darwisch, Torsten Schmidt, Phong Nguyen, Zuzana Fajfrova, Klaus Matschke, Utz Kappert
OBJECTIVE: To analyze the feasibility and advantages of transcranial doppler sonography (TCD) for monitoring and optimization of selective cerebral perfusion (SCP) in aortic arch surgery. METHODS: From April 2013 to April 2014, nine patients with extensive aortic pathology underwent surgery under moderate hypothermic cardiac arrest with unilateral antegrade SCP under TCD monitoring in our institution. Adequate sonographic window and visualization of circle of Willis were to be confirmed...
June 16, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28648533/recurrent-laryngeal-nerve-injury-and-swallowing-dysfunction-in-neonatal-aortic-arch-repair
#6
Kamal K Pourmoghadam, William M DeCampli, Mark Ruzmetov, James Kosko, Sami Kishawi, Michael O'Brien, Amanda Cowden, Kurt Piggott, Harun Fakioglu
BACKGROUND: We evaluated the incidence, clinical effect, and recovery rate of vocal cord dysfunction (VCD) and swallowing dysfunction in neonates undergoing aortic arch repair. METHODS: We retrospectively evaluated 101 neonates who underwent aortic arch reconstruction from 2008 to 2015. Direct flexible laryngoscopy was performed in 89 patients before initiation of postoperative oral feeding after Norwood (n = 63) and non-Norwood (n = 26) arch reconstruction. We defined VCD as immobility of vocal cords or their lack of coaptation and poor mobility...
June 22, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28643998/survey-in-expert-clinicians-on-validity-of-automated-calculation-of-optimal-cerebral-perfusion-pressure
#7
Romy Steijn, Roy Stewart, Marek Czosnyka, Joseph Donnelly, Ari Ercole, Antony Absalom, Jan W Elting, Christina Haubrich, Peter Smielewski, Marcel Aries
BACKGROUND: Optimal cerebral perfusion pressure (CPPopt) targeting in traumatic brain injury (TBI) patients constitutes an active and controversial area of research. It has been suggested that an autoregulation guided CPP therapy may improve TBI outcome. Prerequisites of a CPPopt intervention study would be objective criteria for the CPPopt detection.. This study compared the agreement between automated and visual CPPopt detection. METHODS: Twenty-five clinicians from 18 centres worldwide, familiar with brain monitoring and using dedicated software, reviewed ten 4-hour CPPopt screenshots at 48 hrs after ictus in selected TBI patients...
June 22, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28637170/neuroprotective-effect-of-pressure-oriented-flow-regulation-and-ph-stat-management-in-selective-antegrade-brain-perfusion-during-total-aortic-arch-repair
#8
Hisato Ito, Toru Mizumoto, Yasuhiro Sawada, Kazuya Fujinaga, Hironori Tempaku, Yasunori Yamamoto, Katsuhiro Tsutsui, Hideto Shimpo
OBJECTIVES: The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump. METHODS: Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28624894/suppression-of-tlr4-nf-%C3%AE%C2%BAb-signaling-pathway-improves-cerebral-ischemia-reperfusion-injury-in-rats
#9
Hang Zhao, Zhuo Chen, Li-Juan Xie, Gui-Feng Liu
The present study aimed to investigate the effects of the toll-like receptor 4 (TLR4)/nuclear factor-kappaB (NF-ҡB) signaling pathway in cerebral ischemia-reperfusion injury. A total of 125 male Sprague Dawley (SD) rats were selected for this study. Fifty SD rats were randomly divided into the control, sham injury, 0.5 h perfusion, 2 h perfusion, and 6 h perfusion groups to establish the model of ischemia-reperfusion. The rat brain injury model was established using the other 75 male SD rats, and different model groups with different treatments were established (15 rats per group): model control group (injected with 10 μL of saline solution), model + TAK-242 group (injected with resatorvid), model + PDTC group (injected with pyrrolidine dithiocarbamate), model + LPS group (injected with lipopolysaccharide), and sham injury group (incision to the neck skin and injected with 10 μL of saline solution for normal rats)...
June 17, 2017: Molecular Neurobiology
https://www.readbyqxmd.com/read/28616347/intraoperative-care-for-aortic-surgery-using-circulatory-arrest
#10
REVIEW
Félix Ezequiel Fernández Suárez, David Fernández Del Valle, Adrián González Alvarez, Blanca Pérez-Lozano
The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28614970/effect-of-cerebrospinal-fluid-drainage-on-brain-tissue-oxygenation-in-traumatic-brain-injury
#11
Omar S Akbik, Mark Krasberg, Edwin M Nemoto, Howard Yonas
The effectiveness of cerebrospinal fluid (CSF) drainage in lowering high intracranial pressure (ICP) is well established in severe traumatic brain injury (TBI). However, recently the use of external ventricular drains and intracranial pressure monitors in traumatic brain injury has come under question. The aim of this retrospective study was to investigate the effect of CSF drainage on brain tissue oxygenation (PbtO2). Using a multimodality monitoring system, we continuously monitored brain tissue oxygenation (PbtO2) and parenchymal ICP during CSF drainage events via a ventriculostomy in 40 patients with severe traumatic brain injury (TBI)...
June 14, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28611933/monochorionic-triamniotic-triplet-pregnancy-complicated-by-twin-reversed-arterial-perfusion-sequence-case-report-and-literature-review
#12
Pingshan Pan, Guoyang Luo, Lu Tang, Jeanne D Rolle, Yuqin Qin, Quan Zeng, Jiangting Wei, Yuanfang Chen, Hongwei Wei
Background  Monochorionic-triamniotic pregnancies are rare and fraught with complications. Case  A case of monochorionic-triamniotic triplet pregnancy complicated by twin reversed arterial perfusion (TRAP) sequence is presented. The patient declined termination or selective fetal reduction. Triplet C was acardiac. At 24 weeks, triplet B developed polyhydramnios. At 30 weeks, polyhydramnios was seen in all three amniotic sacs, but without signs of fetal hydrops and with normal Doppler velocimetry measurements in the umbilical artery, middle cerebral artery, and ductus arteriosus of triplets A and B...
April 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28598243/advances-in-arterial-spin-labelling-mri-methods-for-measuring-perfusion-and-collateral-flow
#13
Matthias Jp van Osch, Wouter M Teeuwisse, Zhensen Chen, Yuriko Suzuki, Michael Helle, Sophie Schmid
With the publication in 2015 of the consensus statement by the perfusion study group of the International Society for Magnetic Resonance in Medicine (ISMRM) and the EU-COST action 'ASL in dementia' on the implementation of arterial spin labelling MRI (ASL) in a clinical setting, the development of ASL can be considered to have become mature and ready for clinical prime-time. In this review article new developments and remaining issues will be discussed, especially focusing on quantification of ASL as well as on new technological developments of ASL for perfusion imaging and flow territory mapping...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28587332/three-dimensional-arterial-spin-labeling-imaging-and-dynamic-susceptibility-contrast-perfusion-weighted-imaging-value-in-diagnosing-glioma-grade-prior-to-surgery
#14
Hong Ma, Zizheng Wang, Kai Xu, Zefeng Shao, Chun Yang, Peng Xu, Xiaohua Liu, Chunfeng Hu, Xin Lu, Yutao Rong
The current study aimed to investigate whole-brain three-dimensional arterial spin labeling imaging (3D ASL) and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI), in regards to their diagnostic value of preoperative glioma grade. The parameter values obtained after correction will be correlated with the diagnostic value of 3D ASL and DSC-PWI perfusion. In the current study, 50 patients with gliomas confirmed by pathology were used, including 27 low-grade gliomas (LGGs) and 23 high-grade gliomas (HGGs)...
June 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28579039/total-mismatch-of-diffusion-weighted-imaging-and-susceptibility-weighted-imaging-in-patients-with-acute-cerebral-ischemia
#15
Min-Gyu Park, Jeong A Yeom, Seung Kug Baik, Kyung-Pil Park
BACKGROUND AND PURPOSE: Multiple hypointense vessels (MHV) on susceptibility-weighted imaging (SWI) is associated with an increased oxygen demand in acute cerebral ischemia. Occasionally, some patients exhibit extensive MHV on SWI despite of negative diffusion-weighted imaging (DWI), which is a phenomenon called total mismatch DWI-SWI. We analyzed the clinical characteristics and imaging findings in patients with the total DWI-SWI mismatch. MATERIALS AND METHODS: We selected patients with total DWI-SWI mismatch who underwent MRI within 12hours from onset...
May 31, 2017: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/28551049/hypothermia-and-selective-antegrade-cerebral-perfusion-is-safe-for-arch-repair-in-type-a-dissection
#16
W Brent Keeling, Bradley G Leshnower, John C Hunting, Jose Binongo, Edward P Chen
BACKGROUND: Unilateral selective antegrade cerebral perfusion with moderate hypothermic circulatory arrest has been shown to be a safe and effective method of cerebral protection during surgery for acute type A dissection. This study evaluates the impact of this cerebral protection strategy on clinical outcomes after extended aortic arch reconstruction in patients undergoing emergent repair of acute type A dissection. METHODS: A retrospective review from 2004 to 2016 at a US academic center of patients undergoing surgery for acute type A dissections using moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion was performed...
May 24, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28496083/-retrograde-type-a-aortic-dissection-after-thoracic-endovascular-aortic-repair-report-of-a-case
#17
Sei Morizumi, Takafumi Inoue, Satoshi Nishi, Akihiro Yoshimoto, Masashi Fujisaki, Yoshihiro Suematsu
A 72-year-old man presented with aneurysms of the distal aortic arch and the distal descending aorta due to chronic type B aortic dissection. We first performed thoracic endovascular aortic repair (TEVAR) in the distal descending aorta, and the aneurysm was successfully excluded using a Gore Tag stentgraft. Seven days after TEVAR, computed tomography revealed retrograde type A aortic dissection occurring from the ascending aorta to the distal aortic arch. In emergency surgery, ascending aorta and total arch replacement were performed under selective cerebral perfusion with moderate hypothermia, and after coming off cardiopulmonary bypass, the distal aortic arch aneurysm was excluded using a Gore Tag stentgraft...
May 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28465460/efficacy-of-stent-retriever-thrombectomy-in-magnetic-resonance-imaging-versus-computed-tomographic-perfusion-selected-patients-in-swift-prime-trial-solitaire-fr-with-the-intention-for-thrombectomy-as-primary-endovascular-treatment-for-acute-ischemic-stroke
#18
RANDOMIZED CONTROLLED TRIAL
Nicolas Menjot de Champfleur, Jeffrey L Saver, Mayank Goyal, Reza Jahan, Hans-Christoph Diener, Alain Bonafe, Elad I Levy, Vitor M Pereira, Christophe Cognard, Dileep R Yavagal, Gregory W Albers
BACKGROUND AND PURPOSE: The majority of patients enrolled in SWIFT PRIME trial (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) had computed tomographic perfusion (CTP) imaging before randomization; 34 patients were randomized after magnetic resonance imaging (MRI). METHODS: Patients with middle cerebral artery and distal carotid occlusions were randomized to treatment with tPA (tissue-type plasminogen activator) alone or tPA+stentriever thrombectomy...
June 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28424017/computed-tomography-perfusion-based-selection-of-endovascularly-treated-acute-ischaemic-stroke-patients-are-there-lessons-to-be-learned-from-the-pre-evidence-era
#19
Marios-Nikos Psychogios, Michael Knauth, Raya Bshara, Katharina Schregel, Ioannis Tsogkas, Ismini Papageorgiou, Ilko Maier, Jan Liman, Daniel Behme
Introduction Some of the latest groundbreaking trials suggest that noncontrast cranial computed tomography and computed tomography-angiography are sufficient tools for patient selection within six hours of symptom onset. Before endovascular stroke therapy became the standard of care, patient selection was one of the most useful tools to avoid futile reperfusions. We report the outcomes of endovascularly treated stroke patients selected with a perfusion-based paradigm and discuss the implications in the current era of endovascular treatment...
April 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28414895/the-impact-of-ct-perfusion-threshold-on-predicted-viable-and-nonviable-tissue-volumes-in-acute-ischemic-stroke
#20
Xuya Huang, Dheeraj Kalladka, Bharath Kumar Cheripelli, Fiona Catherine Moreton, Keith W Muir
BACKGROUND AND PURPOSE: Perfusion imaging is used for patient selection in clinical practice and trials. Postprocessing and definitions of tissue viability are nevertheless not standardized. We compared the lesion volumes generated with two well-recognized perfusion tissue definitions in a single-center phase 2 thrombolysis study. METHODS: We analyzed perfusion imaging data from the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study using two popular tissue viability thresholds (ischemic core definition: (1) cerebral blood volume < 2...
April 17, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
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