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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)

Submitter: 川堀 真人

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