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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Aortocarotid bypass for hemispheric hypoperfusion in a child
Nader Sanai1, Heather Fullerton, Tom R Karl
1Department of Neurological Surgery, University of California at San Francisco, California 94143-0112, USA.
Journal of Neurosurgery. Pediatrics
|April 2, 2008
Summary
Pediatric large-vessel vasculitis is rare but serious. A microsurgical aortocarotid bypass using a saphenous vein graft effectively treated a 10-month-old with severe brain hypoperfusion, resolving symptoms.
Area of Science:
- Vascular Surgery
- Pediatric Cardiology
- Pediatric Neurology
Background:
- Large-vessel vasculitis is a rare but severe condition in children, potentially causing significant morbidity.
- Obliterative arteriopathy and aortitis can lead to critical hypoperfusion in pediatric patients.
- Symptomatic hemispheric hypoperfusion presents a significant clinical challenge in infants.
Observation:
- A unique case of presumed vasculitis with aortitis and severe obliterative arteriopathy was observed in a 10-month-old infant.
- The patient presented with symptomatic hemispheric hypoperfusion, indicating compromised brain blood flow.
- Standard treatments may be limited in such complex pediatric vascular conditions.
Findings:
- Microsurgical revascularization via a unilateral aortocarotid bypass was performed using a cryopreserved saphenous vein allograft.
- This intervention successfully restored normal intracranial perfusion bilaterally.
- The patient experienced a resolution of ischemic symptoms post-procedure.
Implications:
- Aortocarotid bypass is a clinically effective and technically feasible surgical option for treating severe hypoperfusion in young children.
- Saphenous vein allografts are a viable option for pediatric aortocarotid bypass procedures.
- The bypass graft's potential for future angioplasty or stenting offers a long-term management strategy for potential delayed stenosis.
