Why the study?
Patients undergoing aortic arch surgery face a high risk of poor neurological outcomes, requiring effective strategies to maintain cerebral and spinal cord perfusion.
This review highlights that moderate hypothermia with selective antegrade cerebral perfusion and targeted cerebrospinal fluid drainage are key strategies to minimize stroke and paraplegia risks during aortic arch surgery.
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May guide neuroprotection in aortic arch surgery; leaves open need for RCTs to confirm optimal strategies.
Perioperative management of patients undergoing surgeries of the aortic arch is challenging. This cohort of patients has a high risk of poor neurological outcomes both as a consequence of the disease process as well as the methods employed during surgical management. Many strategies have been put forward to ameliorate these complications; however, maintaining cerebral and spinal cord perfusion and reducing metabolic oxygen demand is the core principle of these strategies. Moderate hypothermia and selective ante-grade perfusion are the most promising methods that provide the best conditions for the competing requirements of both the brain and spinal cord. Intraoperative and postoperative monitoring is essential for early detection and intervention in delayed spinal cord ischaemia and stroke. In this article we aim to discuss the current methods of neuroprotection and spinal cord protection in aortic arch surgery and stenting.
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Myers et al. (2025) studied this question.
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