The Detection of Microemboli in the Middle Cerebral Artery during Cardiopulmonary Bypass: A Transcranial Doppler Ultrasound Investigation Using Membrane and Bubble Oxygenators

Padayachee, T.S.; Parsons, S.; Theobold, R.; Linley, John E.; Gosling, R. G.; Deverall, P B

doi:10.1016/s0003-4975(10)62077-2

Cited by 254 publications

(92 citation statements)

References 20 publications

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“…Although the etiology of postoperative stroke is multifactorial, hypoperfusion arising from a severely stenotic carotid artery or embolization from an ulcerated plaque, calcific debris from a diseased valve, or introduction of air during the procedure are important mechanisms. [2][3][4][5] Indeed, the risk of stroke in patients with carotid disease after CABG has been estimated at 1.8% in patients with stenoses Ͻ50%, 3.2% in patients with stenoses between 50% and 99%, and 10% in patients with contralateral occlusion. 1 A number of randomized studies have demonstrated a clear benefit from carotid endarterectomy in reducing stroke risks.…”

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confidence: 99%

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Mahmoudi

Hill

Zhang

et al. 2011

Stroke

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Background and Purpose— Stroke development is a major concern in patients undergoing coronary artery bypass grafting (CABG). Whether asymptomatic severe carotid artery stenosis (CAS) contributes to the development of stroke and mortality in such patients remains uncertain. Methods— A retrospective analysis of 878 consecutive patients with documented carotid duplex ultrasound who underwent isolated CABG in our institution from January 2003 to December 2009 was performed. Patients with severe CAS (n=117) were compared with those without severe CAS (n=761) to assess the rates of stroke and mortality during hospitalization for CABG. The 30-day mortality rate was also assessed. Results— Patients with severe CAS were older and had a higher prevalence of peripheral arterial disease and heart failure. Patients with severe CAS had similar rates of in-hospital stroke (3.4% versus 3.6%; P =1.0) and mortality (3.4% versus 4.2%; P =1.0) compared with patients without severe CAS. The 30-day rate of mortality was also similar between the 2 cohorts (3.4% versus 2.9%; P =0.51). Conclusions— Severe CAS alone is not a risk factor for stroke or mortality in patients undergoing CABG. The decision to perform carotid imaging and subsequent revascularization in association with CABG must be individualized and based on clinical judgment.

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confidence: 99%

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Mahmoudi

Hill

Zhang

et al. 2011

Stroke

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“…We used intraoperative transcranial Doppler (TCD) to measure cerebral microemboli load [4,52]. Monitoring was continuous, beginning before the operation started, ie, before the skin incision, and continuing until no microembolus had been detected for 2 minutes and when the patient was returned to the supine position after THA.…”

Section: Methodsmentioning

confidence: 99%

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Patel

Stygall

Harrington

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundIntraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. Questions/purposes We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. Methods The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. Results Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. Conclusions Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.

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“…In 1980, a spectrogram display of an aeromicroemboli was obtained by Merril Spencer for the first time. Five years after introduction of Doppler insonation of intracranial arteries with 2 MHz probes by Rune Aaslid in 1982, gaseous microembolism during coronary by-pass was shown in the middle cerebral arteries (MCA) by Padayachee (2). In 1990, Merril Spencer reported a similar but lower intensity signals in the MCA during manipulation of the carotid arteries before arteriotomy during carotid endarterectomy (3).…”

Section: öZetmentioning

confidence: 99%

Neurosonology of emboli detection and monitoring

Topçuoğlu¹,

Arsava²

2012

Türk Beyin Damar Hast Derg

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Cerebral embolism is the leading cause of ischemic stroke. Detection of microembolic signals [MES] in cerebral circulation is uniquely attained by several transcranial Doppler techniques, and can not be obtained with any other available imaging modality. Albeit no uniform picture has emerged from the studies, presence and amount of MES can identify a high-risk status in the setting of potential arterial or cardiac sources of cerebral embolism. Real-time MES monitoring during vascular procedures with high cerebral embolism risk seems also promising. The potential of MES detection in improvement of patient care is usually acknowledged, even though several aspects remain yet to be scientifically established. We herein review theory, technique and clinical potential of the neurosonological emboli detection, and try to add to understanding of the journal readership about the recent development on this subject.

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The Detection of Microemboli in the Middle Cerebral Artery during Cardiopulmonary Bypass: A Transcranial Doppler Ultrasound Investigation Using Membrane and Bubble Oxygenators

Cited by 254 publications

References 20 publications

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Neurosonology of emboli detection and monitoring

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