Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler.
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.
Tanoue
Y
Y
Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan. tanoue@heart.med.kyushu-u.ac.jp
Tominaga
R
R
Ochiai
Y
Y
Fukae
K
K
Morita
S
S
Kawachi
Y
Y
Yasui
H
H
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017585:Ultrasonography, Doppler, Transcranial