Advertisement

Anesthesia for Cerebrovascular Lesions

  • Shiwani Jain
  • Manish Kumar Marda
Chapter

Abstract

Cerebrovascular lesions include a wide array of conditions involving the arteries and veins of the cerebral circulation. Lesions such as carotid artery stenosis, Moyamoya disease, and cerebral arteriovenous malformations have complex pathophysiology, and the spectrum of symptoms can range from headache, transient ischemic attack, ischemic stroke, and seizures to potentially fatal intracerebral hemorrhage. The anesthetic management of these conditions can be very challenging because patients can be of extremes of age with multisystem involvement. Perioperative optimization is a priority; however sometimes patients present with imminent life-threatening crisis and need to be taken up for emergency surgery.

Keywords

Carotid endarterectomy Carotid artery stenting Moyamoya disease EDAS Arteriovenous malformation Intracerebral hemorrhage Vein of Galen malformation Dural AV fistula 

References

  1. 1.
    Rothwell PM, Slattery J, Warlow CP. A systematic comparison of the risks of stroke and death due to carotid endarterectomy for symptomatic and asymptomatic stenosis. Stroke. 1996;27:266–9.CrossRefGoogle Scholar
  2. 2.
    Barnett HJ, Taylor DW, Eliasziw M, Fox AJ, Ferguson GG, Haynes RB, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1998;339:1415–25.CrossRefGoogle Scholar
  3. 3.
    Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, et al. Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361:107–16.CrossRefGoogle Scholar
  4. 4.
    North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445.CrossRefGoogle Scholar
  5. 5.
    Faggioli G, Pini R, Mauro R, et al. Contralateral carotid occlusion in endovascular and surgical carotid revascularization: a single centre experience with literature review and meta-analysis. Eur J Vasc Endovasc Surg. 2013;46:10.CrossRefGoogle Scholar
  6. 6.
    North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group, Gasecki AP, Eliasziw M, Ferguson GG, et al. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg. 1995;83:778.CrossRefGoogle Scholar
  7. 7.
    Sundt TM Jr, Sandok BA, Whisnant JP. Carotid endarterectomy: complications and preoperative assessment of risk. Mayo Clin Proc. 1975;50:301.PubMedGoogle Scholar
  8. 8.
    Hofmann R, Kypta A, Steinwender C, et al. Coronary angiography in patients undergoing carotid artery stenting shows a high incidence of significant coronary artery disease. Heart. 2005;91:1438–41.CrossRefGoogle Scholar
  9. 9.
    Hertzer NR, Young JR, Beven EG, et al. Coronary angiography in 506 patients with extracranial cerebrovascular disease. Arch Intern Med. 1985;145:849–52.CrossRefGoogle Scholar
  10. 10.
    McGirt MJ, Woodworth GF, Brooke BS, et al. Hyperglycaemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. Neurosurgery. 2006;58:1066–73.CrossRefGoogle Scholar
  11. 11.
    Cohen N, Hobson RW II, Weiss DG, Chimowitz M, VA Cooperative Study 167 Group. Death associated with asymptomatic carotid artery stenosis: long-term clinical evaluation. J Vasc Surg. 1993;18:1002–9.. discussion 1009–11.CrossRefGoogle Scholar
  12. 12.
    Venkatachalam S, Shishenbor MH. Management of carotid disease in patients undergoing coronary artery bypass surgery: is it time to change our approach? Curr Opin Cardiol. 2011;26:480–7.CrossRefGoogle Scholar
  13. 13.
    Halm EA, Hannan EL, Rojas M, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg. 2005;42:420–8.CrossRefGoogle Scholar
  14. 14.
    Lewis SC, Warlow CP, Bodenham AR, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008;372:2132–42.CrossRefGoogle Scholar
  15. 15.
    McCulloch TJ, Thompson CI, Turner MJ. A randomized crossover comparison of the effects of propofol and sevoflurane on cerebral hemodynamics during carotid endarterectomy. Anesthesiology. 2007;106:56–64.CrossRefGoogle Scholar
  16. 16.
    Sundt TM Jr, Sharbrough FW, Piepgras DG, et al. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy. Mayo Clin Proc. 1981;56:533–43.PubMedGoogle Scholar
  17. 17.
    Harada RN, Comerota AJ, Good GM, et al. Stump pressure, electroencephalographic changes, and the contralateral carotid artery: another look at selective shunting. Am J Surg. 1995;170:148–53.CrossRefGoogle Scholar
  18. 18.
    Salvian AJ, Taylor DC, Hsiang YN, Hildebrand HD, Litherland HK, Humer MF, et al. Selective shunting with EEG monitoring is safer than routine shunting for carotid endarterectomy. Cardiovasc Surg. 1997;5:481–5.CrossRefGoogle Scholar
  19. 19.
    Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended release metoprolol succinate in patients undergoing noncardiac surgery (POISE trial): a randomized controlled trial. Lancet. 2008;371:1839–47.CrossRefGoogle Scholar
  20. 20.
    Durham CA, Ehlert BA, Agle SC, et al. Role of statin therapy and angiotensin blockade in patients with asymptomatic moderate carotid artery stenosis. Ann Vasc Surg. 2012;26:344–52.CrossRefGoogle Scholar
  21. 21.
    Sharpe RY, Dennis MJS, Nasim A, et al. Dual antiplatelet therapy prior to carotid endarterectomy reduces post-operative embolisation and thromboembolic events: post-operative transcranial doppler monitoring is now unnecessary. Eur J Vasc Endovasc Surg. 2010;40:162–7.CrossRefGoogle Scholar
  22. 22.
    Markus HS, Droste DW, Kaps M, Larrue V, Lees KR, Siebler M, et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation. 2005;111:2233–40.CrossRefGoogle Scholar
  23. 23.
    Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Stroke. 2004;35:1227–8.CrossRefGoogle Scholar
  24. 24.
    Chechik O, Goldstein Y, Behrbalk E, et al. Blood loss and complications following carotid endarterectomy in patients treated with clopidogrel. Vascular. 2012;20:193–7.CrossRefGoogle Scholar
  25. 25.
    Bond R, Narayan SK, Rothwell PM, et al. Clinical and radiographic risk factors for operative stroke and death in the European carotid surgery trial. Eur J Vascendovasc Surg. 2002;23:108–16.CrossRefGoogle Scholar
  26. 26.
    Goldstein LB, McCrory DC, Landsman PB, et al. Multicenter review of preoperative risk factors for carotid endarterectomy in patients with ipsilateral symptoms. Stroke. 1994;25:1116–21.CrossRefGoogle Scholar
  27. 27.
    Kragsterman B, Logason K, Ahari A, et al. Risk factors for complications after carotid endarterectomy—a population-based study. Eur J Vasc Endovasc Surg. 2004;28:98–103.CrossRefGoogle Scholar
  28. 28.
    Bond R, Rerkasem K, Rothwell PM. Systematic review of the risks of carotid endarterectomy in relation to the clinical indication for and timing of surgery. Stroke. 2003;34:2290–301.CrossRefGoogle Scholar
  29. 29.
    Sidawy AN, Aidinian G, Johnson ON 3rd, et al. Effect of chronic renal insufficiency on outcomes of carotid endarterectomy. J Vasc Surg. 2008;48:1423–30.CrossRefGoogle Scholar
  30. 30.
    Tu JV, Wang H, Bowyer B, Green L, Fang J, Kucey D, et al. Risk factors for death or stroke after carotid endarterectomy. Observations from the Ontario Carotid Endarterectomy registry. Stroke. 2003;34:2568–75.CrossRefGoogle Scholar
  31. 31.
    Towne JB, Bernhard VM. The relationship of postoperative hypertension to complications following carotid endarterectomy. Surgery. 1980;88:575–80.PubMedGoogle Scholar
  32. 32.
    Hans SS, Glover JL. The relationship of cardiac and neurological complications to blood pressure changes following carotid endarterectomy. Am Surg. 1995;61:356–9.PubMedGoogle Scholar
  33. 33.
    Debing E, Van Den BP. Does the type, number or combinations of traditional cardiovascular risk factors affect early outcome after carotid endarterectomy? Eur J Vasc Endovasc Surg. 2006;31:622–6.CrossRefGoogle Scholar
  34. 34.
    Naylor AR, Bolia A, Abbott RJ, Pye IF, Smith J, Lennard N. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg. 1998;28:326–34.CrossRefGoogle Scholar
  35. 35.
    Brooks WH, McClure RR, Jones MR, Coleman TC, Breathitt L. Carotid angioplasty and stenting versus carotid endarterectomy: randomized trial in a community hospital. J Am Coll Cardiol. 2001;38:1589–95.CrossRefGoogle Scholar
  36. 36.
    Brooks WH, Jones MR, Gisler P, McClure RR, Coleman TC, Breathitt L, et al. Carotid angioplasty with stenting versus endarterectomy: 10-year randomized trial in a community hospital. JACC Cardiovasc Interv. 2014;7:163–8.CrossRefGoogle Scholar
  37. 37.
    Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357:1729–37.Google Scholar
  38. 38.
    Yadav JS, Wholey MH, Kuntz RE, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;35:1493–501.CrossRefGoogle Scholar
  39. 39.
    Brott TG, Hobson RW 2nd, Howard G, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11–23.CrossRefGoogle Scholar
  40. 40.
    Lal BK, Beach KW, Roubin GS, Lutsep HL, Moore WS, Malas MB, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11:755–63.CrossRefGoogle Scholar
  41. 41.
    Suzuki J, Takaku A. Cerebrovascular “Moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20:288–99.CrossRefGoogle Scholar
  42. 42.
    Fujimura M, Tominaga T. Current status of revascularization surgery for Moyamoya disease: special consideration for its ‘internal carotid-external carotid (IC-EC) conversion’ as the physiological reorganization system. Tohoku J Exp Med. 2015;236:45–53.CrossRefGoogle Scholar
  43. 43.
    Miyamoto S, Yoshimoto T, Hashimoto N, Okada Y, Tsuji I, Tominaga T, Nakagawara J, Takahashi JC, Investigators JAMT. Effects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease: results of the Japan adult Moyamoya trial. Stroke. 2014;45:1415–21.CrossRefGoogle Scholar
  44. 44.
    Sinha PK, Neema PK, Rathod RC. Anesthesia and intracranial arteriovenous malformation. Neurol India. 2004;52(2):163–70.PubMedGoogle Scholar
  45. 45.
    Miller C, Mirski M. Anesthesia considerations and intraoperative monitoring during surgery for arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am. 2012;23(1):153–64.  https://doi.org/10.1016/j.nec.2011.09.014.CrossRefPubMedGoogle Scholar
  46. 46.
    Mohr JP, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614–21.CrossRefGoogle Scholar
  47. 47.
    Yih PS, Cheong KF. Anaesthesia for caesarean section in a patient with an intracranial arteriovenous malformation. Anaesth Intensive Care. 1999;27(1):66–8.CrossRefGoogle Scholar
  48. 48.
    Ashida Y, Miyahara H, Sawada H, Mitani Y, Maruyama K. Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension. Paediatr Anaesth. 2005;15(6):525–8.CrossRefGoogle Scholar
  49. 49.
    McLeod ME, Creighton RE, Humphreys RP. Anaesthetic management of arteriovenous malformations of the vein of Galen. Can Anaesth Soc J. 1982;29(4):307–12.CrossRefGoogle Scholar
  50. 50.
    Hrishi AP, Lionel KR. Periprocedural management of vein of Galen aneurysmal malformation patients: an 11-year experience. Anesth Essays Res. 2017;11(3):630–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Shiwani Jain
    • 1
  • Manish Kumar Marda
    • 1
  1. 1.Department of Neuroanaesthesia and Critical CareMax Super Speciality Hospital VaishaliGhaziabadIndia

Personalised recommendations