Original Articles
Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler

https://doi.org/10.1016/S0003-4975(98)01186-2Get rights and content

Abstract

Background. Retrograde cerebral perfusion (RCP) is a simple technique and is expected to provide cerebral protection. However, its optimum management and limitations remain unclear. Transcranial Doppler has been used to monitor cerebral perfusion. Using this Doppler technique, we compared cerebral blood flow for RCP with that for selective cerebral perfusion.

Methods. Thirty-two consecutive patients underwent elective surgical repair of an aortic aneurysm involving the aortic arch at Kyushu University Hospital. Retrograde cerebral perfusion was used in 15 patients and selective cerebral perfusion, in 17 patients. Continuous measurement of middle cerebral artery blood flow velocities was performed by transcranial Doppler technique.

Results. Retrograde middle cerebral artery blood flow velocities during RCP could be measured in only 3 patients, whereas middle cerebral artery blood flow velocities during selective cerebral perfusion could be measured in all but 1 woman. The increase in middle cerebral artery blood flow velocities after RCP was significantly greater than that after selective cerebral perfusion.

Conclusions. The measurement of middle cerebral artery blood flow velocities with transcranial Doppler technique is practicable during selective cerebral perfusion but difficult during RCP. The increase in middle cerebral artery blood flow velocities after RCP indicates reactive hyperemia and reflects the critical decrease in cerebral blood flow during this type of perfusion.

Section snippets

Material and methods

From April 1993 to January 1997, 32 consecutive patients electively underwent resection and graft replacement of ascending aortic, transverse aortic arch, or descending thoracic aortic aneurysms at Kyushu University Hospital. Retrograde cerebral perfusion was used in 15 patients (RCP group) and SCP, in 17 patients (SCP group) for cerebral protection during the reconstruction of the aortic arch. This was a randomized, prospective study, and informed consent was obtained from all patients.

Results

The two groups were similar with respect to operation time (RCP group, 636 ± 183 minutes; SCP group, 656 ± 254 minutes), CPB time (RCP group, 281 ± 87 minutes; SCP group, 271 ± 93 minutes), aortic cross-clamp time (RCP group, 64.4 ± 44.9 minutes; SCP group, 78.4 ± 32.4 minutes), and circulatory arrest time of the lower body (RCP group, 33.4 ± 20.7 minutes; SCP group, 33.8 ± 17.5 minutes). Data on cerebral perfusion are shown in Table 2. The duration of RCP was significantly shorter than that of

Comment

Strategies for protecting the brain during operations for aortic aneurysms involving the aortic arch have evolved into three major categories: HCA, SCP, and RCP. Hypothermic circulatory arrest is the simplest and provides a good operative field but has the disadvantage of a time limit in terms of safety [12]. Selective cerebral perfusion is a useful adjunct when reconstruction of the aortic arch and arch vessels is likely to take a long time. However, SCP requires complicated techniques for

Acknowledgements

This study was supported in part by the Research Grant of Cardiovascular Disease (6C-3) from the Ministry of Health and Welfare, Japan.

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