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Hypothermia during Carotid Endarterectomy: A Safety Study

BACKGROUND: CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect...

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Autores principales: Candela, Serena, Dito, Raffaele, Casolla, Barbara, Silvestri, Emanuele, Sette, Giuliano, Filippi, Federico, Taurino, Maurizio, Brancadoro, Domitilla, Orzi, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825931/
https://www.ncbi.nlm.nih.gov/pubmed/27058874
http://dx.doi.org/10.1371/journal.pone.0152658
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author Candela, Serena
Dito, Raffaele
Casolla, Barbara
Silvestri, Emanuele
Sette, Giuliano
Filippi, Federico
Taurino, Maurizio
Brancadoro, Domitilla
Orzi, Francesco
author_facet Candela, Serena
Dito, Raffaele
Casolla, Barbara
Silvestri, Emanuele
Sette, Giuliano
Filippi, Federico
Taurino, Maurizio
Brancadoro, Domitilla
Orzi, Francesco
author_sort Candela, Serena
collection PubMed
description BACKGROUND: CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe. METHODS: The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. RESULTS: All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. CONCLUSIONS: Systemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. TRIAL REGISTRATION: ClinicalTrials.gov NCT02629653
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spelling pubmed-48259312016-04-22 Hypothermia during Carotid Endarterectomy: A Safety Study Candela, Serena Dito, Raffaele Casolla, Barbara Silvestri, Emanuele Sette, Giuliano Filippi, Federico Taurino, Maurizio Brancadoro, Domitilla Orzi, Francesco PLoS One Research Article BACKGROUND: CEA is associated with peri-operative risk of brain ischemia, due both to emboli production caused by manipulation of the plaque and to potentially noxious reduction of cerebral blood flow by carotid clamping. Mild hypothermia (34–35°C) is probably the most effective approach to protect brain from ischemic insult. It is therefore a substantial hypothesis that hypothermia lowers the risk of ischemic brain damage potentially associated with CEA. Purpose of the study is to test whether systemic endovascular cooling to a target of 34.5–35°C, initiated before and maintained during CEA, is feasible and safe. METHODS: The study was carried out in 7 consecutive patients referred to the Vascular Surgery Unit and judged eligible for CEA. Cooling was initiated 60–90 min before CEA, by endovascular approach (Zoll system). The target temperature was maintained during CEA, followed by passive, controlled rewarming (0.4°C/h). The whole procedure was carried out under anesthesia. RESULTS: All the patients enrolled had no adverse events. Two patients exhibited a transient bradycardia (heart rate 30 beats/min). There were no significant differences in the clinical status, laboratory and physiological data measured before and after CEA. CONCLUSIONS: Systemic cooling to 34.5–35.0°C, initiated before and maintained during carotid clamping, is feasible and safe. TRIAL REGISTRATION: ClinicalTrials.gov NCT02629653 Public Library of Science 2016-04-08 /pmc/articles/PMC4825931/ /pubmed/27058874 http://dx.doi.org/10.1371/journal.pone.0152658 Text en © 2016 Candela et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Candela, Serena
Dito, Raffaele
Casolla, Barbara
Silvestri, Emanuele
Sette, Giuliano
Filippi, Federico
Taurino, Maurizio
Brancadoro, Domitilla
Orzi, Francesco
Hypothermia during Carotid Endarterectomy: A Safety Study
title Hypothermia during Carotid Endarterectomy: A Safety Study
title_full Hypothermia during Carotid Endarterectomy: A Safety Study
title_fullStr Hypothermia during Carotid Endarterectomy: A Safety Study
title_full_unstemmed Hypothermia during Carotid Endarterectomy: A Safety Study
title_short Hypothermia during Carotid Endarterectomy: A Safety Study
title_sort hypothermia during carotid endarterectomy: a safety study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825931/
https://www.ncbi.nlm.nih.gov/pubmed/27058874
http://dx.doi.org/10.1371/journal.pone.0152658
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