scholarly journals Physiological Advantages of Cerebral Blood Flow During Carotid Endarterectomy Under Local Anaesthesia. A Randomised Clinical Trial

2002 ◽  
Vol 24 (3) ◽  
pp. 215-221 ◽  
Author(s):  
R.J. McCarthy ◽  
M.K. Nasr ◽  
P. McAteer ◽  
M. Horrocks
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Endarterectomy ◽  
Local Anaesthesia ◽  
Randomised Clinical Trial

scholarly journals The Effects of Cerebral Vasospasm on Cerebral Blood Flow and the Effects of Induced Hypertension: A Mathematical Modelling Study

2019 ◽  
Vol 8 (2-6) ◽  
pp. 152-163
Author(s):  
Pervinder Bhogal ◽  
Leonard Leong Yeo ◽  
Lucas O. Müller ◽  
Pablo J. Blanco
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Mean Arterial Pressure ◽  
Randomised Clinical Trial ◽  
Whole Body ◽  
Arterial Circulation ◽  
Arterial Network ◽  
Induced Hypertension ◽  
Diffuse Spasm

Background: Induced hypertension has been used to promote cerebral blood flow under vasospastic conditions although there is no randomised clinical trial to support its use. We sought to mathematically model the effects of vasospasm on the cerebral blood flow and the effects of induced hypertension. Methods: The Anatomically Detailed Arterial Network (ADAN) model is employed as the anatomical substrate in which the cerebral blood flow is simulated as part of the simulation of the whole body arterial circulation. The pressure drop across the spastic vessel is modelled by inserting a specific constriction model within the corresponding vessel in the ADAN model. We altered the degree of vasospasm, the length of the vasospastic segment, the location of the vasospasm, the pressure (baseline mean arterial pressure [MAP] 90 mm Hg, hypertension MAP 120 mm Hg, hypotension), and the presence of collateral supply. Results: Larger decreases in cerebral flow were seen for diffuse spasm and more severe vasospasm. The presence of collateral supply could maintain cerebral blood flow, but only if the vasospasm did not occur distal to the collateral. Induced hypertension caused an increase in blood flow in all scenarios, but did not normalise blood flow even in the presence of moderate vasospasm (30%). Hypertension in the presence of a complete circle of Willis had a marginally greater effect on the blood flow, but did not normalise flow. Conclusion: Under vasospastic condition, cerebral blood flow varies considerably. Hypertension can raise the blood flow, but it is unable to restore cerebral blood flow to baseline.

Cerebral Blood Flow before and After Carotid Endarterectomy

1972 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
H.C. Engell ◽  
Gudrun Boysen ◽  
H.J. Ladegaard-Pedersen ◽  
H. Henriksen
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Endarterectomy ◽  
Before And After

P4-305: IMPACT OF SIMVASTATIN ON CEREBRAL BLOOD FLOW, PULSATILITY INDEX, AND ALZHEIMER'S DISEASE BIOMARKERS: A CLINICAL TRIAL

2006 ◽  
Vol 14 (7S_Part_30) ◽  
pp. P1571-P1571
Author(s):  
Natanya S. Russek ◽  
Sara Elizabeth Berman ◽  
Karen K. Lazar ◽  
Yue Ma ◽  
Carson A. Hoffman ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trial ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Pulsatility Index ◽  
Disease Biomarkers ◽  
Flow Pulsatility

Comparison of Monitoring of Cerebral Blood Flow by c-FLOW and Transcranial Doppler in Carotid Endarterectomy

2018 ◽  
Vol 111 ◽  
pp. e686-e692
Author(s):  
Xu Wang ◽  
Bin Yang ◽  
Yan Ma ◽  
Peng Gao ◽  
Yabing Wang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Endarterectomy ◽  
Transcranial Doppler

First-In-Human Robot-Assisted Subretinal Drug Delivery Under Local Anaesthesia A Randomised Clinical Trial

2021 ◽  
Author(s):  
Jasmina Cehajic-Kapetanovic ◽  
Kanmin Xue ◽  
Thomas L. Edwards ◽  
Thijs C. Meenink ◽  
Maarten J. Beelen ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Clinical Trial ◽  
Local Anaesthesia ◽  
Randomised Clinical Trial ◽  
Robot Assisted

scholarly journals Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical study

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi-peng Xiao ◽  
ke Jin ◽  
Jie-qing Wan ◽  
Yong Lin ◽  
Yao-hua Pan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ischemic Stroke ◽  
Multimodal Imaging ◽  
Imaging Techniques ◽  
Trial Registry ◽  
Clinical Trial Registry ◽  
Cerebrovascular Reserve ◽  
Randomized Controlled

Abstract Background Cerebrovascular reactivity (CVR) is the change in cerebral blood flow in response to a vaso-active stimulus, and may assist the treatment strategy of ischemic stroke. However, previous studies reported that a therapeutic strategy for stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters (e.g., cerebral blood flow and CVR). Hence, measurement of CVR by multimodal imaging techniques may improve the treatment of ischemic stroke. Methods/design This is a prospective, randomized, controlled clinical trial that aimed to examine the capability of multimodal imaging techniques for the evaluation of CVR to improve treatment of patients with ischemic stroke. A total of 66 eligible patients will be recruited from Renji Hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR > 10% group and CVR < 10% group. The patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary endpoint is all adverse events and ipsilateral stroke recurrence at 6, 12, and 24 months after management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, and 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, parallel, randomized, controlled registry study, together with other ongoing studies, should present more evidence for optimal individualized accurate treatment of ischemic stroke. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009635; Registered on 16 October 2016. All items are from the World Health Organization Trial Registration Data Set and registration in the Chinese Clinical Trial Registry: ChiCTR-IOR-16009635.

Correlation of Regional Cerebral Blood Flow with Ischemic Electroencephalographic Changes during Sevoflurane-Nitrous Oxide Anesthesia for Carotid Endarterectomy 

1998 ◽  
Vol 88 (4) ◽  
pp. 892-897 ◽  
Author(s):  
Robert E. Grady ◽  
Margaret R. Weglinski ◽  
Frank W. Sharbrough ◽  
William J. Perkins
Keyword(s):  
Blood Flow ◽  
Nitrous Oxide ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cerebral Blood Flow ◽  
Carotid Endarterectomy ◽  
Regional Cerebral Blood Flow ◽  
Carotid Occlusion ◽  
Regional Cerebral Blood ◽  
Eeg Changes

Background Carotid endarterectomy necessitates temporary unilateral carotid artery occlusion. Critical regional cerebral blood flow (rCBF) has been defined as the rCBF below which electroencephalographic (EEG) changes of ischemia occur. This study determined the rCBF50, the rCBF value at which 50% of patients will not demonstrate EEG evidence of cerebral ischemia with carotid cross-clamping. Methods Fifty-two patients undergoing elective carotid endarterectomy were administered 0.6-1.2% (0.3-0.6 minimum alveolar concentration) sevoflurane in 50% nitrous oxide (N2O). A 16-channel EEG was used for monitoring. The washout curves from intracarotid 133Xenon injections were used to calculate rCBF before and at the time of carotid occlusion by the half-time (t(1/2)) technique. The quality of the EEG with respect to ischemia detection was assessed by an experienced electroencephalographer. Results Ischemic EEG changes developed in 5 of 52 patients within 3 min of carotid occlusion at rCBFs of 7, 8, 11, 11, and 13 ml x 100 g(-1) x min(-1). Logistic regression analysis was used to calculate an rCBF50 of 11.5 +/- 1.4 ml x 100 g(-1) x min(-1) for sevoflurane. The EEG signal demonstrated the necessary amplitude, frequency, and stability for the accurate detection of cerebral ischemia in all patients within the range of 0.6-1.2% sevoflurane in 50% N2O. Conclusions The rCBF50 of 0.6-1.2% sevoflurane in 50% N2O, as determined using logistic regression analysis, is 11.5 +/- 1.4 ml 100 g(-1) x min(-1). Further, in patients anesthetized in this manner, ischemic EEG changes due to carotid occlusion were accurately and rapidly detected.

scholarly journals Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy.

Stroke ◽  
1989 ◽  
Vol 20 (1) ◽  
pp. 53-58 ◽  
Author(s):  
J H Halsey ◽  
H A McDowell ◽  
S Gelmon ◽  
R B Morawetz
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Carotid Endarterectomy ◽  
Cerebral Artery ◽  
Regional Cerebral Blood Flow ◽  
Blood Velocity ◽  
Regional Cerebral Blood

Adverse effects of pre-existing cerebral small vessel disease on cognitive improvement after carotid endarterectomy

2019 ◽  
Vol 15 (6) ◽  
pp. 657-665 ◽  
Author(s):  
Jun Yoshida ◽  
Fumio Yamashita ◽  
Makoto Sasaki ◽  
Kunihiro Yoshioka ◽  
Shunrou Fujiwara ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
White Matter ◽  
Carotid Endarterectomy ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Cognitive Improvement ◽  
Vessel Disease

Background Although patients with improved cognition after carotid endarterectomy usually exhibit postoperative restoration of cerebral blood flow, less than half of patients with such cerebral blood flow change have postoperatively improved cognition. Cerebral small vessel disease on magnetic resonance imaging is associated with irreversible cognitive impairment. Aims The purpose of the present prospective study was to determine whether pre-existing cerebral small vessel disease affects cognitive improvement after carotid endarterectomy. Methods Brain MR imaging was performed preoperatively, and the number or grade of each cerebral small vessel disease was determined in 80 patients undergoing carotid endarterectomy for ipsilateral internal carotid artery stenosis (≥70%). The volume of white matter hyperintensities relative to the intracranial volume was also calculated. Brain perfusion single-photon emission computed tomography and neuropsychological testing were performed preoperatively and two months postoperatively. Based on these data, a postoperative increase in cerebral blood flow and postoperative improved cognition, respectively, were determined. Results Logistic regression analysis using the sequential backward elimination approach revealed that a postoperative increase in cerebral blood flow (95% confidence interval [CI], 10.74–3730.00; P = 0.0004) and the relative volume of white matter hyperintensities (95% CI, 0.01–0.63; P = 0.0314) were significantly associated with postoperative improved cognition. Although eight of nine patients with postoperative improved cognition exhibited both a relative volume of white matter hyperintensities <0.65% and a postoperative increase in cerebral blood flow, none of patients with a relative volume of white matter hyperintensities ≥0.65% had postoperative improved cognition regardless of any postoperative change in cerebral blood flow. Conclusion Pre-existing cerebral white matter hyperintensities on magnetic resonance imaging adversely affect cognitive improvement after carotid endarterectomy.

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