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The Journal of Cardiovascular Surgery 2000 April;41(2):299-302

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Vertebral artery surgery with cardiopulmonary bypass and deep hypothermia

Demaria R. G., Albat B., Frapier J. M., Bodino M., Chaptal P. A.

From the Thoracic and Cardiovascular Surgery Unit Arnaud de Villeneuve Hospital, Montpellier Cedex (France)


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Deep hypo­ther­mia was pro­posed to pre­vent neu­ro­nal ische­mia and ­stroke dur­ing sur­gi­cal pro­ce­dures on arter­ies ­that sup­ply the ­brain, espe­cial­ly ­with extend­ed occlu­sive ­lesions on ­both inter­nal carot­id arter­ies. The inter­est of ­this ther­a­peu­tic ­option is ­still ­under dis­cus­sion, ­even in the ­case of com­bined car­diac and cereb­ro­vas­cu­lar sur­gery. We ­report the ­case of a 53-­year-old ­male who was admit­ted to our insti­tu­tion for symp­to­mat­ic ver­teb­ro­bas­i­lar insuf­fi­cien­cy. Angiography ­showed a throm­bo­sis of ­both inter­nal carot­id arter­ies, sten­o­sis of ­both exter­nal carot­id arter­ies, and a ­tight prox­i­mal sten­o­sis of a dom­i­nant ­right ver­te­bral ­artery. Endarterectomy and angio­plas­ty of the ori­gin of the ­right exter­nal carot­id ­artery was ­done ­first to ­increase the ­blood sup­ply to the ­brain via col­lat­er­al arter­ies con­nect­ing the ­extra- and intra­cra­ni­al net­works. Six ­weeks ­after ­this, a ­right-sid­ed ver­te­bral-to-carot­id ­artery anas­tom­o­sis was per­formed dur­ing car­di­o­pul­mo­nary ­bypass (CPB)-­induced ­deep hypo­ther­mia for opti­mal neu­ro­nal pro­tec­tion, ­with ­good ­results. However, ear­ly throm­bo­sis of the ­right ver­te­bral ­artery requir­ing re-inter­ven­tion in nor­mo­ther­mia, with­out any ­stroke, indicate ­that ­deep hypo­ther­mia was unnec­es­sary in ­this ­case, prob­ably ­because of the pre­vi­ous nat­u­ral and sur­gi­cal devel­op­ment of col­lat­er­al cir­cu­la­tion. However, ­there was no ­means of pre­dict­ing ­this in a reli­able man­ner ­before the pro­ce­dure and ­deep hypo­ther­mia ­appeared a ­safe tech­nique for neu­ro­nal pro­tec­tion with­out any spe­cif­ic post­op­er­a­tive com­pli­ca­tions.

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