Reduced Risk of Brain Infarction During a Heart Surgery Using Sonolysis – Pilot Results
Authors:
E. Hurtíková 1; M. Roubec 1; M. Kuliha 1,2; A. Goldírová 1; J. Havelka 3; R. Brát 4; M. Bortlíček 4; R. Herzig 5; D. Školoudík 1,2,6
Authors place of work:
Neurologická klinika LF OU a FN Ostrava
1; Neurologická klinika 1. LF UK a VFN v Praze
2; Ústav radiodiagnostický, LF OU a FN Ostrava
3; Kardiochirurgické centrum, FN Ostrava
4; Neurochirurgická a neuroonkologická klinika ÚVN – VFN Praha
5; Fakulta zdravotnických věd, UP v Olomouci
6
Published in the journal:
Cesk Slov Neurol N 2015; 78/111(4): 430-434
Category:
Original Paper
Summary
Background:
Heart surgery is burdened with a significant risk of ischemic stroke. Asymptomatic cerebral infarctions can be detected in as many as 32% of patients after heart surgery. The aim of this study is to prove the efficacy of sonolysis (continual transcranial Doppler (TCD) monitoring) during open-heart surgery to decrease the risk of new brain infarctions detected by magnetic resonance imaging (MRI).
Material and methods:
Patients indicated to isolated coronary artery bypass or isolated one heart valve surgery were included in the study. Patients were randomized to a sonolysis group (TCD monitoring), and to a control group without sonolysis. All patients underwent brain MRI before and 24 hours after the surgery and the presence of new ischemic lesions was evaluated.
Results:
During 16 months, 78 patients (48 males, mean age 63.7 ± 15.8 years) were enrolled to the study. Thirty five patients were randomized to the sonolysis group and 43 to the control group. In the sonolysis group, new brain infarctions were found in eight (23%) patients – in the right (TCD-monitored) MCA territory in five patients (14%) but > 0.5 cm3 in two (6%) patients only. In the control group, new infarctions were found in 10 patients (23%) – in the right (TCD-monitored) MCA in eight (19%) patients and > 0.5 cm3 in five (12 %) (p > 0.05 in all cases).
Conclusion:
Pilot study results showed a trend towards reduction in a number and volume of new brain ischemic lesions in patients treated with sonolysis during heart surgery.
Key words:
ultrasound – sonolysis – brain ischemia – coronary artery bypass graft – heart valve – magnetic resonance imaging – brain
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.
Zdroje
1. Goldemund D, Mikulík R. Neurologické komplikace operací v mimotělním oběhu. Inter Med 2003; 3: 22– 26.
2. Geier P, Ehler E. Iatrogenní cévní mozkové příhody. Neurol Praxi 2003; 3: 137– 139.
3. Almassi GH, Sommers T, Moritz TE, Laurie A, Shover W, London MJ et al. Stroke in cardiac surgical patients: determinants and outcome. Ann Thorac Surg 1999; 68(2): 391– 397.
4. Salazar JD, Wityk RJ, Grega MA, Borowicz LM, Doty JR,Petrofski JA et al. Stroke after cardiac surgery: short- and long‑term outcomes. Ann Thorac Surg 2001; 72(4): 1195– 1201.
5. Müllges W, Babin‑Ebell J, Reents W, Toyka VK. Cognitive performance after coronary artery bypass grafting: a follow‑up study. Neurology 2002; 58(5): 741– 743.
6. Hogue Ch, Murphy S, Schechtman K, Davila‑ Roman V. Risk factors for early or delayed stroke after cardiac surgery. Circulation 1999; 100(6): 642– 647.
7. Cook DJ, Huston J, Tenerry MR, Brown RD, Zehr KJ, Sundt TM. Postcardiac surgical cognitive impairment in the aged using diffusion‑ weighted magnetic resonance imaging. Ann Thorac Surg 2007; 83(1): 1389– 1395.
8. Taylor KM. Brain damage during open‑ heart surgery. Thorax 1982; 37(4): 873– 876.
9. Carrascal Y, Casquero E, Gualis J, Di Stefano S, Florez S, Fulquet E et al. Cognitive decline after cardiac surgery: proposal for easy measurement with a new test. Interact Cardiovasc Thorac Surg 2005; 4(3): 216– 221.
10. Shann KG, Likosky DS, Murkin JM, Baker RA, Baribeau YA,DeFoe GR et al. An evidence‑based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg 2006; 132(2): 283– 290.
11. Zamvar V, Williams D, Hall J. Assessment of neurocognitive impairment after off‑ pump and on‑ pump techniques for coronary artery bypass graft surgery: prospective randomized controlled trial. BMJ 2002; 325(7375): 1268– 1273.
12. Akiyama M, Ishibashi T, Yamada T, Furuhata H. Low‑ frequency ultrasound penetrates the cranium and enhances thrombolysis in vitro. Neurosurgery 1998; 43(4): 828– 832.
13. Behrens S, Daffertshofer M, Spiegel D, Hennerici M. Low‑ frequency, low‑ intensity ultrasound accelerates thrombolysis through the skull. Ultrasound Med Biol 1999; 25(2): 269– 273.
14. Daffertshoffer M, Hennerici M. Ultrasound in the treatment of ischaemic stroke. Lancet Neurol 2003; 2(5): 283– 290.
15. Školoudik D, Fadrna T, Bar M, Zapletalova O, Zapletal O, Blatný J. Changes in hemocoagulation in heathly volunteers after a 1 hour trombotripsy using a diagnostic 2– 4Hz probe. J Thromb Thrombolysis 2008; 26(2): 119– 124.
16. Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR,Sabin JA et al. Ultrasound‑ enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004; 351(21): 2170– 2178.
17. Eggers J, Seidel G, Koch B, König IR. Sonothrombolysis in acute ischemic stroke for patients ineligible for rt‑ PA. Neurology 2005; 64(12): 1052– 1054.
18. Eggers J, König IR, Koch B, Händler G, Seidel G. Sonothrombolysis with transcranial color‑ coded sonography and recombinant tissue‑type plasminogen activator in acute middle cerebral artery main stem occlusion: results from a randomized study. Stroke 2008; 39(5): 1470– 1475. doi: 10.1161/ STROKEAHA.107.503870.
19. Školoudik D, Bar M, Skoda O, Václavík D, Hradilek P, Simickova K. Bezpečnost a účinnost trombotripse – akcelerace trombolýzy pomocí ultrazvuku. Cesk Slov Neurol N 2004; 67/ 100(2): 157– 161.
20. Skoloudik D, Bar M, Skoda O, Václavík D, Hradílek P, Allendoefer J et al. Safety and efficacy od the sonografic acceleration of the middle cerebral artery recanalization: results of the pilot Thrombotripsy study. Ultrasound Med Biol 2008; 34(11): 1775– 1782. doi: 10.1016/ j.ultrasmedbio.2008.04.002.
21. Šaňák D, Herzig R, Školoudík D, Horák D, Zapletalová J,Köcher M et al.The safety and efficacy of continuous transcranial duplex Doppler monitoring of middle cerebral artery occlusion in acute stroke patients: comparison of TCDD and thrombolysis in MCA recanalization. J Neuroimaging 2010; 20(1): 58– 63. doi: 10.1111/ j.1552‑ 6569.2008.00354.x.
22. Widimský P, Straka Z. Indikace ke koronárnímu bypassu. Cor Vasa 2006; 7(11): 392– 398.
23. Želizko M. Indikace k revaskularizaci myokardu u chronické stabilní anginy pectoris. Interv Akut Kardiol 2007; 6(3): 79– 80.
24. Popelová J, Benešová M, Brtko M. Doporučené postupy pro diagnostiku a léčbu chlopenních srdečních vad v dospělosti. Cor Vasa 2007; 6(7): 195– 234.
25. Školoudik D, Skoda O, Bar M, Brozman M, Vaclavik D. Neurosonologie. Praha: Galen 2003.
Štítky
Paediatric neurology Neurosurgery NeurologyČlánok vyšiel v časopise
Czech and Slovak Neurology and Neurosurgery
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