OBJECTIVES This study sought to examine the safety, efficacy, and economic implications of the use of cerebral protection devices during carotid artery angioplasty and stenting (CAS) in high-risk patients with severe carotid artery disease (CAD). METHODS A comprehensive search for peer- and non-peer-reviewed studies that compared carotid endarterectomy (CEA) or CAS without cerebral protection...

Surgical therapy for aortic arch disease involves partial or complete replacement of the aortic arch with reimplantation of the great vessels while the cerebral blood flow is temporarily altered. Patients undergoing this mandatory period of circulatory arrest during arch replacement are at an increased risk for adverse neurologic outcomes, and strategies for cerebral protection must be implemen...

BACKGROUND AND PURPOSE Whether cerebral protection during carotid angioplasty and stenting (CAS) is associated with a lower risk of periprocedural stroke or death remains to be established. We report on 80 patients randomized in the CAS arm of the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis trial comparing CAS (with or without cerebral protection) with...

Despite many advances in perioperative care, cerebral injury from cardiac surgery remains an important source of patient morbidity and mortality. This injury has a range of clinical manifestations, including stroke and encephalopathy, which occur in 1–3% and 10–15% of patients, respectively. Postoperative cognitive dysfunction (POCD) is more common, affecting 15–40% of patients 1 month after su...

Previous clinical trials failed to show the benefit of several potentially protective drugs in acute ischemic stroke. However, there would be three main approaches for brain protection against stroke. The first is to develop a novel thrombolytic agent which is more efficient and safer than alteplase. Tenecteplase and desmoteplase are in progress as a new thrombolytic drug. The second strategy i...

Administration of the various anesthetic agents including barbiturates results in a dose-related reduction in CMRO2 and cerebral blood flow. The maximum reduction occurs with the dose that results in electrocerebral silence. At this point, energy utilization associated with EEG activity has been reduced to zero, but energy utilization for cellular homeostasis persists unchanged. Additional barb...

BACKGROUND AND OBJECTIVES Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents. CONTENT Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmac...

Extreme whole-body hyperthermia was achieved without lasting side effects in canines by elevating body core temperature to 42 degrees C, using a warm water bath. Cold water irrigation of the nasal alar fold permitted an additional core temperature elevation of 0.5-1.0 degrees C above brain temperature for periods up to 1.5 h. The brain-core temperature differential was maintained by a physiolog...