[Severe Carotid Artery Disease:Monitoring and Precautions for Prevention of Cerebral Ischemia]
Yusuke Suzuki1, Yoshikatsu Saiki
1Department of Cardiovascular Surgery, Tohoku University, Sendai, Japan.
Insights
Preventing stroke during heart surgery is crucial. Evaluating carotid artery stenosis before surgery and monitoring brain oxygen levels with near-infrared cerebral oxygen monitors (rSO2) can reduce risks.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Context:
- Cerebrovascular complications are a known risk in cardiovascular surgery.
- Accurate diagnosis and evaluation of carotid artery stenosis are vital pre-operatively.
- Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are options for severe stenosis but not always performed.
Purpose:
- To highlight the importance of pre-operative carotid artery stenosis evaluation.
- To discuss intraoperative management strategies for cerebral protection.
- To emphasize the utility of cerebral oxygen monitoring during surgery.
Summary:
- Maintaining mean arterial pressure between 50-70 mmHg during cardiopulmonary bypass is recommended.
- Perioperative monitoring of cerebral metabolism and circulation using near-infrared cerebral oxygen monitors (e.g., rSO2) is beneficial.
- These measures aim to prevent the exacerbation of cerebral ischemia.
Impact:
- Improved patient outcomes in cardiovascular surgery by reducing stroke incidence.
- Enhanced understanding of cerebral protection strategies during complex cardiac procedures.
- Potential for wider adoption of advanced monitoring techniques in surgical settings.
Abstract:
Cerebrovascular complications in cardiovascular surgery have long been documented. It is very important to diagnose and evaluate the stenosis of carotid artery before cardiovascular surgery. When indicated, carotid endarterectomy( CEA) or carotid artery stenting( CAS) for severe carotid artery stenosis may be considered before cardiovascular surgery. However, it has not been necessary performed in the real-world. It seems to be appropriate to maintain a mean arterial pressure of 50-70 mmHg during cardiovascular surgery with extracorporeal circulation. In addition, perioperative cerebral metabolism and circulation monitoring using a near-infrared cerebral oxygen monitor such as rSO2 is very useful from the viewpoint of preventing exacerbation of cerebral ischemia.
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