Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization

Background and Objectives During transmyocardial laser revascularization (TMLR), multiple microembolic signals (MES) can be detected in cerebral arteries. We sought to characterize composition and clinical relevance of these MES and to evaluate strategies to reduce cerebral microembolization during...

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Bibliographic Details
Published in:	Lasers in surgery and medicine Vol. 34; no. 5; pp. 379 - 384
Main Authors:	Gerriets, Tibo, Grossherr, Martin, Misfeld, Martin, Nees, Urs, Reusche, Ernst, Stolz, Erwin, Sievers, Hans H., Kaps, Manfred, Kraatz, Ernst G.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-06-2004
Subjects:	Animals Brain - pathology brain embolism cerebral protection Echoencephalography Intracranial Embolism - diagnostic imaging Intracranial Embolism - etiology Intracranial Embolism - pathology Intracranial Embolism - prevention & control Laser Therapy - adverse effects Laser Therapy - methods lasers Myocardial Revascularization - adverse effects Myocardial Revascularization - methods Oxygen - blood Partial Pressure Swine ultrasound
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Summary:	Background and Objectives During transmyocardial laser revascularization (TMLR), multiple microembolic signals (MES) can be detected in cerebral arteries. We sought to characterize composition and clinical relevance of these MES and to evaluate strategies to reduce cerebral microembolization during TMLR. Study Design/Materials and Methods TMLR was performed in pigs. Laser energy was set to 4–10 J (group A) or 80 J (group B). Oxygen concentration was varied between 21 and 100%. MES were recorded in the ophthalmic artery. Brain and spinal cord were investigated histologically after 10 days. Results More MES could be detected during high‐ compared to low‐energy laser procedures. Ventilation with 100% oxygen reduced the number of MES. No lesions were found on histology. Conclusions The number of MES depends on the laser energy. Laser‐induces cavitation‐effects lead to an additional release of nitrogen bubbles. Thus, the microembolic load can be reduced by ventilation with 100% oxygen and by decreasing the laser energy. Lasers Surg. Med. 34:379–384, 2004. © 2004 Wiley‐Liss, Inc.
Bibliography:	ark:/67375/WNG-TPBLBKDZ-M istex:500D0432FD9F53DCBE06088CF09D964BCA271967 ArticleID:LSM20030 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0196-8092 1096-9101
DOI:	10.1002/lsm.20030