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Non-invasive assessment of cerebral perfusion pressure: Applied towards preoperative planning of aortic arch surgery with selective antegrade cerebral perfusion
Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).ORCID iD: 0000-0002-2031-722X
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.ORCID iD: 0000-0001-6784-1945
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2025 (English)In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 179, article id 112459Article in journal (Refereed) Published
Abstract [en]

Selective antegrade cerebral perfusion (SACP) is a protective procedure to ascertain adequate brain perfusion during aortic arch surgeries requiring moderate hypothermic circulatory arrest. SACP entails catheterization of arteries feeding the brain, which can be done bilaterally (bSACP) or unilaterally (uSACP), but there is no consensus on when to use each approach. bSACP may increase the risk of embolization, while uSACP risks hypoperfusion due to insufficient perfusion pressure in the contralateral hemisphere, since a single catheter must perfuse both hemispheres. We developed and tested the feasibility of a new method for predicting cerebral perfusion pressures (CPP) during SACP, which could potentially aid clinicians in preoperatively identifying which SACP approach to use. Feasibility of the method was evaluated in five patients eligible for aortic arch surgery (65 ± 7 years, 3 men). Patients were investigated preoperatively with computed tomography angiography (CTA) and 4D flow magnetic resonance imaging (MRI) to assess patient-specific arterial anatomy and blood flows. From the imaging, computational fluid dynamics (CFD) simulations estimated the patients' vascular resistances. Applying these resistances and intraoperative SACP pressure/flow settings to the model's boundary conditions allowed for predictions of contralateral CPP during SACP. Predicted pressures were compared to corresponding intraoperative pressure measurements. The method showed promise for predicting contralateral CPP during both uSACP (median error (range): 2.4 (−0.2–18.0) mmHg) and bSACP (0.8 (−3.3–5.4) mmHg). Predictions were most sensitive to collateral artery size. This study showed the feasibility of CPP predictions of SACP, and presents key features needed for accurate modelling.

Place, publisher, year, edition, pages
Elsevier, 2025. Vol. 179, article id 112459
Keywords [en]
4D flow MRI, Aortic arch surgery, Cerebral perfusion pressure, Computational fluid dynamics, Selective antegrade cerebral perfusion
National Category
Surgery Physiology and Anatomy
Identifiers
URN: urn:nbn:se:umu:diva-233313DOI: 10.1016/j.jbiomech.2024.112459ISI: 001383269200001PubMedID: 39662261Scopus ID: 2-s2.0-85211374967OAI: oai:DiVA.org:umu-233313DiVA, id: diva2:1924192
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Region VästerbottenAvailable from: 2025-01-03 Created: 2025-01-03 Last updated: 2025-02-10Bibliographically approved

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Vikström, AxelEklund, AndersWåhlin, AndersZarrinkoob, LalehMalm, JanAppelblad, MicaelHolmlund, Petter

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Vikström, AxelEklund, AndersWåhlin, AndersZarrinkoob, LalehMalm, JanAppelblad, MicaelHolmlund, Petter
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Department of Diagnostics and InterventionUmeå Centre for Functional Brain Imaging (UFBI)Department of Public Health and Clinical MedicineDepartment of Applied Physics and ElectronicsNeurosciences
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Journal of Biomechanics
SurgeryPhysiology and Anatomy

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