PURPOSE We studied the neurotoxicity of carbon dioxide as a contrast agent in the central nervous system by performing CO2 digital subtraction angiography (DSA) in the aortic arch and its branches in experimental animals. METHODS Twenty-five rabbits underwent intraarterial CO2 DSA while under general anesthesia, during which 50 angiograms were obtained after administration of 3 mL/kg CO2. MR imaging was performed before and after the angiographic procedure. The animals were killed 12 hours later and their brains examined macroscopically and microscopically. RESULTS Three animals died of a cause irrelevant to CO2. No animal had clinical symptoms of hemiplegia or stroke. Neither MR imaging nor macroscopic and microscopic examination of the brain revealed any ischemic infarct hemorrhage, thrombosis, or foci of necrosis. CONCLUSION The absence of neurologic symptoms, the lack of pathologic findings at MR imaging, and the negative pathologic findings in the brain encourage further research on CO2 neurotoxicity of the central nervous system and support its application in the imaging of intracranial vessels.
Comparison of carotid endarterectomy in patients with and without occluded contralateral carotid artery.evaluation of results without using shunt or patch.<> Hospital, Medical School, University of Athens.235 patients, divided into group I of 40 patients with and group II of 195 patients without occluded contralateral carotid artery.carotid endarterectomy under general anesthesia.heparin administration, stable hemodynamic status during clamping, short duration monitoring postoperatively.Postoperative morbidity of both groups was 2.5% (6/235) and mortality 1.7% (4/235). Group I: mortality rate was 2.5% (1/40) major and minor stroke each 2.5% (1/40) and group I: 1.5% (3/195) and 1% (2/195) respectively (NS). Four to 108 months later, 30% (12/40) of group I and 21% (41/195) of group II died.Endarterectomy of the carotid artery under general anesthesia without use of shunt and patch in patients with or without occlusion of the contralateral carotid artery presented the same comparative results. Candidates for carotid endarterectomy should be screened systematically for coronary disease preoperatively and annual stress testing postoperatively, tactics which may improve early and late mortality rate after carotid surgery.
Simultaneous bilateral carotid endarterectomy (SBCE) has been very rarely cited in the international literature. Twelve patients underwent 24 SBCE's (Group A). They were compared with 22 bilateral staged endarterectomies in 11 (Group B) and 155 cases with unilateral endarterectomies (Group C). The indications and surgical management were similar and the accompanying risk factors were comparable in the 3 groups. Shunt or patch was not used and occlusion time was 13 +/- 2'. Total occlusion time in the SBCE was 25 +/- 3'. The results are comparable in the 3 groups. In the SBCE group one case of TIA was particularly noted together with another case with transient vocal cord paresis; however no death, myocardial infarct, respiratory problems or permanent damage of the central nerves were observed in this group. Despite the small number of our patients together with that of the international literature, it seems that a better preoperative assessment of the function of the circle of Willis in association with meticulous surgical technique and proper patient selection, encourages the tactics of simultaneous bilateral carotid endarterectomy.
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