Stroke and extra-cardiac perfusion: new vantage points in brain protection

This report shows a new spectrum of applications of a concept of brain protection for the cardiothoracic surgeon. The underlying treatment deals with an ischemic/reperfusion injury, and novel applications of principles well known in cardiac surgery will be used to provide brain protection. Unique opportunities arise from the uncommon use of circulatory arrest in infants and adults (1-2% of procedures) to the larger areas of sudden death (450,000 pts/year in the US), stroke (700,000 pts/year) and carotid occlusion for peri-operative endarterectomy, and neurologic problems after CPB (30% incidence). Treatment pathways in sudden death will address the brain during CPR, the body to get a cause of arrest with use of peripheral CPB, and a controlled cardiac reperfusate to correct the underlying lesion. Circulatory arrest provides the model to treat, both this uncommon surgical process, with extension as toward treating stroke with controlled reperfusion. Novel models of pretreatment and warm brain reperfusion, that mimic warm heart reperfusion are suggested. Construction of the ultimate brain reperfusate, and its conditions of delivery will follow the valid and tested development phases of a warm cardioplegic solution, but become directed towards the brain. Old tricks that lead to new goals will become our innovative vantage points.