Right common carotid artery reconstruction after extracorporeal membrane oxygenation: Vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery

Stephen Baumgart, Leopold Streletz, Laurence Needleman, Daniel A. Merton, Philip J. Wolfson, Shobhana A. Desai, Linda M. McKee, Hemant Desai, Alan R. Spitzer, Leonard J. Graziani

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective: Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. Methods: We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. Summary results: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Conclusions: Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely. (J PEDIATR 1994;125:295- 304).

Original languageEnglish
Pages (from-to)295-304
Number of pages10
JournalThe Journal of Pediatrics
Volume125
Issue number2
DOIs
Publication statusPublished - 1994
Externally publishedYes

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Cerebrovascular Circulation
Extracorporeal Membrane Oxygenation
Common Carotid Artery
Blood Vessels
Ligation
Electroencephalography
Circle of Willis
Blood Flow Velocity
Normal Distribution
Middle Cerebral Artery
Carotid Arteries
Neuroimaging
Nervous System
Arteries
Color

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Right common carotid artery reconstruction after extracorporeal membrane oxygenation : Vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery. / Baumgart, Stephen; Streletz, Leopold; Needleman, Laurence; Merton, Daniel A.; Wolfson, Philip J.; Desai, Shobhana A.; McKee, Linda M.; Desai, Hemant; Spitzer, Alan R.; Graziani, Leonard J.

In: The Journal of Pediatrics, Vol. 125, No. 2, 1994, p. 295-304.

Research output: Contribution to journalArticle

Baumgart, Stephen ; Streletz, Leopold ; Needleman, Laurence ; Merton, Daniel A. ; Wolfson, Philip J. ; Desai, Shobhana A. ; McKee, Linda M. ; Desai, Hemant ; Spitzer, Alan R. ; Graziani, Leonard J. / Right common carotid artery reconstruction after extracorporeal membrane oxygenation : Vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery. In: The Journal of Pediatrics. 1994 ; Vol. 125, No. 2. pp. 295-304.
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abstract = "Objective: Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. Methods: We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. Summary results: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Conclusions: Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely. (J PEDIATR 1994;125:295- 304).",
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T2 - Vascular imaging, cerebral circulation, electroencephalographic, and neurodevelopmental correlates to recovery

AU - Baumgart, Stephen

AU - Streletz, Leopold

AU - Needleman, Laurence

AU - Merton, Daniel A.

AU - Wolfson, Philip J.

AU - Desai, Shobhana A.

AU - McKee, Linda M.

AU - Desai, Hemant

AU - Spitzer, Alan R.

AU - Graziani, Leonard J.

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N2 - Objective: Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. Methods: We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. Summary results: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Conclusions: Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely. (J PEDIATR 1994;125:295- 304).

AB - Objective: Right common carotid artery (RCCA) ligation after extracorporeal membrane oxygenation by venoarterial bypass may contribute to lateralized cerebral injury. Reconstruction of this artery after extracorporeal membrane oxygenation has proved feasible but has not been evaluated for neurologic outcome in any substantial series of infants. Methods: We evaluated RCCA reconstruction in 47 infants treated with ECMO and compared their cerebrovascular and neuroanatomic imaging findings, electroencephalograms, and developmental outcomes with those of 93 infants who had no reconstruction. Summary results: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtained after RCCA reconstruction. Right internal carotid and bilateral anterior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with reconstructed RCCA. Electroencephalography did not disclose an increased risk of deterioration or marked abnormalities in infants after reconstruction, nor were neuroimaging findings consistent with an increased number of either focal or generalized abnormalities. Neurodevelopmental follow-up revealed no differences in the incidence of delays between those with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Conclusions: Reconstruction of the RCCA after extracorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment both left and right middle cerebral artery blood flow immediately after decannulation. The long-term consequences of either ligation or reconstruction of the RCCA will require careful scrutiny, however, before either course is recommended routinely. (J PEDIATR 1994;125:295- 304).

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