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Strategies for the reduction of cerebral microembolism during transmyocardial laser revascularization
Author(s) -
Gerriets Tibo,
Grossherr Martin,
Misfeld Martin,
Nees Urs,
Reusche Ernst,
Stolz Erwin,
Sievers Hans H.,
Kaps Manfred,
Kraatz Ernst G.
Publication year - 2004
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.20030
Subject(s) - medicine , revascularization , laser , cardiology , oxygenation , ventilation (architecture) , ultrasound , nuclear medicine , anesthesia , radiology , mechanical engineering , physics , myocardial infarction , optics , engineering
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.