Background

Stroke is a devastating complication of cardiovascular surgeries, and the risk is particularly high for those requiring cardiopulmonary bypass (CPB). Embolic particles generated during the unclamping of the aortic cross-clamp may enter the cerebral circulation, lodging in small vessels. External manual compression of the carotid arteries is a non-invasive technique that has been proposed for cerebral protection during CPB procedures but is not widely deployed.

Methods

The aim of this study is to assess the potential for cerebral emboli reduction with carotid compression using an in vitro model. Experiments were performed with a glass aortic arch model in a mock cardiovascular circuit. Small fluorescent particles were released into the circulation with and without carotid compression, and the particles visualized in the aortic midplane. The number of particles in the aorta and arch branch vessels were counted from the images before, during and following the release of carotid compression for durations of 10, 15 and 20 s. A gamma variate function was fit to the data to describe the bolus dynamics.

Results

Carotid compression for 10 s reduces the number of embolic articles entering the carotid arteries by over 75%. A compression duration of 15–20 s does not result in greater particle reduction than one of 10 s.

Conclusion

Brief compression of the common carotid arteries during cardiovascular interventions has the potential to dramatically reduce the number of cerebral emboli and should be investigated further.

中文翻译：

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手动颈动脉按压是减少脑微栓子的可行替代方法

背景

中风是心血管手术的一种毁灭性并发症，对于需要体外循环 (CPB) 的人来说，风险尤其高。在主动脉交叉钳松开期间产生的栓塞颗粒可能会进入大脑循环，停留在小血管中。颈动脉的外部手动按压是一种非侵入性技术，已被提议用于 CPB 手术期间的脑保护，但并未广泛部署。

方法

本研究的目的是使用体外模型评估颈动脉压迫减少脑栓塞的潜力。在模拟心血管回路中使用玻璃主动脉弓模型进行实验。在颈动脉受压和未受压的情况下，小的荧光颗粒被释放到循环中，并且颗粒在主动脉中平面中可见。在 10、15 和 20 秒的持续时间释放颈动脉压缩之前、期间和之后，从图像中计算主动脉和弓支血管中的颗粒数量。伽马变量函数适合数据以描述推注动力学。

结果

颈动脉压缩 10 秒可将进入颈动脉的栓塞物品数量减少 75% 以上。15-20 秒的压缩持续时间不会比 10 秒之一导致更大的颗粒减少。

结论

在心血管干预期间短暂压迫颈总动脉有可能显着减少脑栓塞的数量，应进一步研究。