Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization
✍ Scribed by Tibo Gerriets; Martin Grossherr; Martin Misfeld; Urs Nees; Ernst Reusche; Erwin Stolz; Hans H. Sievers; Manfred Kaps; Ernst G. Kraatz
- Publisher
- John Wiley and Sons
- Year
- 2004
- Tongue
- English
- Weight
- 189 KB
- Volume
- 34
- Category
- Article
- ISSN
- 0196-8092
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✦ Synopsis
Abstract
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.