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Hypothermia during Carotid Endarterectomy: A Safety Study
Serena Candela1, Raffaele Dito2, Barbara Casolla1
1NESMOS (Neurosciences Mental Health and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
Plos One
|April 9, 2016
Summary
Systemic endovascular cooling to 34.5-35°C before and during carotid endarterectomy (CEA) is feasible and safe. This hypothermia approach may protect the brain from ischemic damage during CEA procedures.
Area of Science:
- Vascular Surgery
- Neurology
- Thermoregulation
Background:
- Carotid endarterectomy (CEA) carries a risk of peri-operative brain ischemia from emboli and reduced cerebral blood flow.
- Mild hypothermia (34-35°C) is a recognized neuroprotective strategy against ischemic insult.
- Hypothermia is hypothesized to mitigate ischemic brain damage associated with CEA.
Purpose of the Study:
- To evaluate the feasibility and safety of systemic endovascular cooling to 34.5-35°C before and during CEA.
- To assess the potential of this hypothermia protocol in preventing CEA-related ischemic brain injury.
Main Methods:
- Seven patients eligible for CEA underwent endovascular cooling using the Zoll system.
- Cooling was initiated 60-90 minutes pre-CEA and maintained throughout the procedure.
- Controlled rewarming occurred post-CEA at a rate of 0.4°C/h under anesthesia.
Main Results:
- No adverse events were reported in any of the enrolled patients.
- Two patients experienced transient bradycardia (heart rate 30 beats/min).
- No significant clinical, laboratory, or physiological differences were observed before and after CEA.
Conclusions:
- Systemic endovascular cooling to 34.5-35.0°C is a feasible and safe method.
- The protocol, initiated before and maintained during carotid clamping, shows promise for neuroprotection during CEA.
