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Therapeutic Strategies for Patients with Internal Carotid or Middle Cerebral Artery Occlusion Complicated by Severe Coronary Artery Disease
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| Title: | Therapeutic Strategies for Patients with Internal Carotid or Middle Cerebral Artery Occlusion Complicated by Severe Coronary Artery Disease |
| Authors: | Kawabori, Masahito Browse this author →KAKEN DB | | Kuroda, Satoshi Browse this author →KAKEN DB | | Terasaka, Shunsuke Browse this author →KAKEN DB | | Nakayama, Naoki Browse this author →KAKEN DB | | Matsui, Yoshiro Browse this author →KAKEN DB | | Kubota, Suguru Browse this author | | Nakamura, Masanori Browse this author | | Nakanishi, Katsuhiko Browse this author | | Okamoto, Fumiyuki Browse this author | | Iwasaki, Yoshinobu Browse this author |
| Keywords: | coronary artery bypass graft | | internal cerebral artery | | middle cerebral artery | | occlusion | | STA-MCA anastomosis | | SPECT | | PET |
| Issue Date: | Apr-2010 |
| Publisher: | Elsevier |
| Journal Title: | World Neurosurgery |
| Volume: | 73 |
| Issue: | 4 |
| Start Page: | 345 |
| End Page: | 350 |
| Publisher DOI: | 10.1016/j.wneu.2010.01.026 |
| PMID: | 20849790 |
| Abstract: | Objective: Ischemic stroke is one of major complications of cardiac surgery. Although current 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 ICA or MCA. Therefore, this preliminary study was aimed to clarify whether preoperative blood flow measurements and prophylactic STA-MCA anastomosis could reduce the incidence of perioperative ischemic stroke during cardiac surgery in patient with total occlusion of the ICA or MCA. Methods: This prospective study included 8 patients who were admitted to undergo cardiac surgery including CABG. All of them had total ICA or MCA occlusion on preoperative MR examinations. Preoperative cerebral blood flow and its reactivity to acetazolamide were quantitatively determined in all 8 patients using SPECT or PET. Results: Preoperative blood flow measurements revealed that 2 (25%) of 8 patients had normal cerebral hemodynamic because of well-developed collaterals. They safely underwent cardiac surgery. However, a marked impairment of cerebral perfusion reserve was identified in 6 (75%) of 8 patients in the ipsilateral hemispheres. Of these, 4 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 would be essential to assess the validity. |
| Rights: | © 2010. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ | | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Type: | article (author version) |
| URI: | http://hdl.handle.net/2115/70793 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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Submitter: 川堀 真人
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