Transmyocardial Laser Revascularization Induces Cerebral Microembolization

Knobelsdorff, G. von; Brauer, Patrick M.; Tonner, Peter H.; Hänel, F.; Naegele, Herbert; Stubbe, Hans-Martin; Esch, Jochen Schulte am

doi:10.1097/00000542-199707000-00008

Cited by 19 publications

(10 citation statements)

References 19 publications

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“…The occurrence of cerebral microemboli during TMLR has been mentioned for the first time in 1996 [8]. However, only a limited number of studies were performed to determine cerebral side-effects related to laser induced microemboli [5,6,9]. No study, so far, assessed the effect of cerebral microembolization during TMLR on brain tissue by means of histopathology.…”

Section: Discussionmentioning

confidence: 99%

“…During TMLR, gas bubbles can be detected inside the left ventricle immediately after each laser procedure by transesophageal echocardiography (TEE) [5,6]. Transcranial Doppler studies have revealed microembolic signals (MES) in cerebral arteries seconds after the laser procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Transcranial Doppler studies have revealed microembolic signals (MES) in cerebral arteries seconds after the laser procedures. These observations indicate that laser-induced brain microembolism occurs during TMLR [5][6][7]. Composition and clinical relevance of these microemboli are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization

et al. 2004

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“…The formation of such microemboli, during transmyocardial laser revascularisation on human subjects, was observed in the middle cerebral artery by von Knobelsdorff et al (1997). The formation of such microemboli, during transmyocardial laser revascularisation on human subjects, was observed in the middle cerebral artery by von Knobelsdorff et al (1997).…”

Section: Collateral Effects Induced By Cavitationmentioning

confidence: 95%

Cavitation in Non-Newtonian Fluids

Brujan

2011

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“…Cerebral emboli, compounds that can result in the formation of cell debris and toxic photoproducts, have been detected during this procedure. 80 Small levels of carbon monoxide and hydrogen cyanide have been detected as well. As this technology advances, multimodality neuromonitoring that includes TCD will likely prove to be a critical component of the surgery.…”

Section: Transmyocardial Laser Revascularizationmentioning

confidence: 99%

Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery

Doblar

2004

Semin Cardiothorac Vasc Anesth

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The brain is the only organ not routinely monitored by any direct method during the administration of anesthesia. Anesthesiologists rely primarily on indirect physiologic evidence provided by blood pressure, peripheral pulse oximetry, heart rate, and respiratory and anesthetic gas concentrations to determine that brain blood flow and oxygenation are adequate. The reasons for this practice are that: (1) after millions of anesthetics significant numbers of adverse neurologic outcomes have not occurred, (2) the interpretation of transcranial Doppler, electroencephalogram, and near-infrared cerebral oximetry requires experienced personnel, and (3) the evidence of cost-benefit to support monitoring is limited. Brain monitoring generally has been confined to procedures where the brain is exposed to unique insults and risks specific to the procedures and where reliance on indirect physiologic evidence of cerebral integrity has been proven to be unreliable. Transcranial Doppler monitoring is valuable in the assessment of established surgical techniques, refinement of recent surgical techniques, and development of new techniques and instrumentation. Brain monitoring with transcranial Doppler is of particular value when deviations from established surgical or anesthetic techniques may place the brain at risk for cerebral hyper- or hypoperfusion, gaseous or particulate embolization, or their combined effects. This paper discusses applications of transcranial Doppler in coronary artery bypass surgery, aortic arch procedures, pediatric cardiac surgery, carotid endarterectomy, and a few other special cases. The insight into cerebral physiology is unique to the continuous window on the brain that transcranial Doppler provides.

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Transmyocardial Laser Revascularization Induces Cerebral Microembolization

Abstract: These data show that microemboli can be detected after laser injection in the middle cerebral artery, although they do not effect Vmean and SjO2. The results suggest that these microemboli do not induce a global oxygen imbalance.

Cited by 19 publications

References 19 publications

Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization

Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization

Cavitation in Non-Newtonian Fluids

Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery

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