Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler

Background: Retrograde cerebral perfusion (RCP) is a simple technique and i s expected to provide cerebral protection. However, ifs optimum management and limitations remain unclear. Transcranial Doppler has been used to monit or cerebral perfusion. Using this Doppler technique, we compared cerebral b lood flow for RCP with that for selective cerebral perfusion. Methods. Thirty-two consecutive patients underwent elective surgical repair of an aortic aneurysm involving the aortic arch at Kyushu University Hospi tal. Retrograde cerebral perfusion was used in 15 patients and selective ce rebral perfusion, in 17 patients. Continuous measurement of middle cerebral artery blood now velocities was performed by transcranial Doppler techniqu e. Results. Retrograde middle cerebral artery blood flow velocities during RCP could be measured in only 3 patients, whereas middle cerebral artery blood flow velocities during selective cerebral perfusion could be measured in a ll but 1 woman. The increase in middle cerebral artery blood flow velocitie s after RCP was significantly greater than that after selective cerebral pe rfusion. Conclusions. The measurement of middle cerebral artery blood flow velocitie s with transcranial Doppler technique is practicable during selective cereb ral perfusion but difficult during RCP. The increase in middle cerebral art ery blood flow velocities after RCP indicates reactive hyperemia and reflec ts the critical decrease in cerebral blood flow during this type of perfusi on. (Ann Thorac Surg 1999;67:672-5) (C) 1999 by The Society of Thoracic Sur geons.