RIGHT COMMON CAROTID-ARTERY RECONSTRUCTION AFTER EXTRACORPOREAL MEMBRANE-OXYGENATION - VASCULAR IMAGING, CEREBRAL-CIRCULATION, ELECTROENCEPHALOGRAPHIC, AND NEURODEVELOPMENTAL CORRELATES TO RECOVERY

Objective: Right common carotid artery (RCCA) ligation after extracorp oreal membrane oxygenation by venoarterial bypass may contribute to la teralized cerebral injury. Reconstruction of this artery after extraco rporeal membrane oxygenation has proved feasible but has not been eval uated for neurologic outcome in any substantial series of infants. Met hods: 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 i nfants who had no reconstruction. Summary results: Color Doppler blood flow imaging revealed that carotid artery patency was usually obtaine d after RCCA reconstruction. Right internal carotid and bilateral ante rior and middle cerebral arterial blood flow velocities were generally higher, and were more symmetrically distributed in infants with recon structed RCCA. Electroencephalography did not disclose an increased ri sk of deterioration or marked abnormalities in infants after reconstru ction, nor were neuroimaging findings consistent with an increased num ber of either focal or generalized abnormalities. Neurodevelopmental f ollow-up revealed no differences in the incidence of delays between th ose with a reconstructed RCCA and those with a ligated RCCA during the first year of life. Conclusions: Reconstruction of the RCCA after ext racorporeal membrane oxygenation may facilitate normal distribution of cerebral blood flow through the circle of Willis, and may augment bot h left and right middle cerebral artery blood flow immediately after d ecannulation. The long-term consequences of either ligation or reconst ruction of the RCCA will require careful scrutiny, however, before eit her course is recommended routinely.