Cerebral Emboli Detected by Transcranial Doppler During Cardiopulmonary Bypass Are Not Correlated With Postoperative Cognitive Deficits

Rodriguez, R; Rubens, Fraser D.; Wozny, Denise; Nathan, Howard J.

doi:10.1161/strokeaha.110.590513

Cited by 55 publications

(35 citation statements)

References 27 publications

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“…Ablation for atrial fibrillation (AF) is also associated with a 13% to 20% prevalence of POCD in patients with AF at longterm follow-up (13). Cerebral micro-emboli caused by the cardiac procedures were initially considered to lead to brain injury and neuropsychological deficits, however, the observation from high-intensity transient signals (HITS) in transcranial Doppler recordings showed no evident correlation between cerebral micro-emboli and POCD (14,15).…”

Section: Overview On Postoperative Cognitive Dysfunctionsmentioning

confidence: 99%

The Role of Inflammation in Postoperative Cognitive Dysfunction

Xu¹,

Yang²,

Terrando³

2014

J Anesth Perioper Med

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Aim of review:Postoperative cognitive dysfunction (POCD) is a common complication following surgery, especially in the elderly population. Surgery exposes patients to extensive trauma, blood loss, and tissue injury, all of which contribute to an inflammatory response. In recent years, inflammation has been shown to be a key contributor to the pathogenesis of cognitive decline and neuroinflammatory processes, both in animal models and initial clinical observations. Method: We review the recent literatures on the proposed mechanisms whereby peripheral trauma leads to cognitive impairments and some of the new neuroprotective strategies that may be implemented to prevent neuroinflammation and POCD. Recent findings: Changes in pro-inflammatory cytokines, alarmins, macrophage activation and blood-brain barrier (BBB) dysfunction have been proven to be related to the pathogenesis of cognitive decline using a variety of models, reagents, and technologies. Strategies to harness these pathways through anti-inflammatory and pro-resolving strategies show remarkable effects in modulating neuronal function, synaptic plasticity, glia activity and memory processes. Summary: Further studies are needed to better identify the patients at higher risk for cognitive decline in the postoperative period and which interventions may be suitable for translation and new clinical trials.

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Section: Overview On Postoperative Cognitive Dysfunctionsmentioning

confidence: 99%

The Role of Inflammation in Postoperative Cognitive Dysfunction

Xu¹,

Yang²,

Terrando³

2014

J Anesth Perioper Med

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“…This conclusion was confirmed in a study of 356 patients, in which no correlation between the emboli and postoperative cognitive decline was observed at 3 months after cardiopulmonary bypass. 11 One published report of neuropsychological testing after catheter ablation of atrial fibrillation examined 5 neurocognitive domains before and at 3 Figure 3. The diminishing cortical lesion identified via diffusion weighted MRI (DWI) from day 1 to day 4 after air injection in animal 2 corresponded to very indistinct discoloration and minor stippling on the fixed-tissue section counterpart on day 4 (top row).…”

Section: Dwi Lesions and Neurocognitive Functionmentioning

confidence: 99%

Microembolism and Catheter Ablation II

Haines

Stewart

Barka

et al. 2013

Circ: Arrhythmia and Electrophysiology

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R ecent reports of asymptomatic cerebral lesions imaged with diffusion weighted MRI (DWI) after catheter ablation of atrial fibrillation have raised concerns about the safety of this procedure. [1][2][3][4][5] It has been speculated that these DWI lesions may be the result of cerebral microembolization, and that they could be a marker for procedure-related clinical stroke risk. 6 In addition, some speculate that the asymptomatic cerebral DWI lesions may, in fact, be associated with subtle abnormalities discernable with neuropsychiatric testing. 7,8 It has been established that thrombus, gas bubbles, and particulate debris (coagulum) can be introduced or produced with left atrial catheterization and catheter ablation in this chamber.9 New data are available on catheter ablation-related subclinical DWI lesions, often seen as punctate hyperintensities, from recent studies. However, the link between the size and characteristics of the emboli, produced with left atrial catheter ablation procedures has not been correlated to clinical stroke or subclinical DWI lesions. Clinical Perspective on p 30Considerable differences have been reported in typical lesion dimensions seen on DWI between various clinical stroke cohorts and patients with asymptomatic cerebral lesions detected on DWI after left atrial catheter ablation. There is a lack of causal data for any of the lesion types. The purpose of this canine study was to elucidate the characteristics of emboli capable of creating the DWI punctate hyperintensities seen in the clinical setting after left atrial catheter ablation procedures. We sought to differentiate the effects of embolizing pure gas microbubbles versus microparticles of smaller and larger size because smaller particles and gas microbubbles might be more likely to occlude flow in terminal cerebral vessels, and produce DWI lesions typical to those seen in asymptomatic patients after atrial fibrillation ablation. MethodsAll animal procedures were approved by and carried out in compliance with a preclinical research protocol by the Institutional Animal Care and Use Committee of the Medtronic Physiological Research Laboratories. General animal husbandry and care was supervised by a veterinary staff in accordance with the guidelines in Background-Asymptomatic cerebral lesions have been observed on diffusion weighted MRI (DWI) scans shortly after catheter ablation of atrial fibrillation, but the pathogenesis of these lesions is incompletely understood. Methods and Results-Twelve dogs underwent selective catheterization of the internal carotid or vertebral arteries. Either a microbubbled mixture of air (1.0-4.0 mL), blood, contrast, and saline (n=5), or heat-dried pulverized blood (particle size <600 μm) mixed with saline and contrast (n=6) was injected. One sham control experiment was performed. MRI scans were performed preinjection, and at 1, 2, and 4 days postinjection. Neurological tests were performed daily. Gross pathology and histopathology were performed on the brains after being euthanized on day 4. Three ...

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“…31 Whatever the mechanism, there is apparently no straightforward association between the number of microemboli released and postoperative pathological changes found on brain imaging or incidence of POCD. 32,33 Systemic inflammation is a feature of all types of surgery, but the use of cardiopulmonary bypass provides an additional source of proinflammatory response by exposing blood to a foreign surface. Inflammation can lead to vessel endothelial dysfunction with significant leak across the blood-brain barrier and tissue edema.…”

Section: Hogan Et Al Fixing Hearts and Protecting Minds 163mentioning

confidence: 99%