Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure

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Directly measuring spinal cord blood flow and spinal cord perfusion pressure via the collateral network: Correlations with changes in systemic blood pressure Yuya Kise, MD, Yukio Kuniyoshi, MD, PhD, Hitoshi Inafuku, MD, PhD, Takaaki Nagano, MD, Tsuneo Hirayasu, MD, PhD, Satoshi Yamashiro, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 1, Pages 360-366 (January 2015) DOI: 10.1016/j.jtcvs.2014.09.121 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Experimental model. AKA, Adamkiewicz artery; ASA, anterior spinal artery; DAP, distal arterial blood pressure; PAP, proximal arterial blood pressure; SAP, segmental arterial pressure; SCBF, spinal cord blood flow; SCPP, spinal cord perfusion pressure. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 360-366DOI: (10.1016/j.jtcvs.2014.09.121) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Experimental protocol. Condition 1, no aortic clamp and no SA clamp (control group); condition 2, L2-L7 SA flow halted with distal perfusion; condition 3, L2-L7 SA flow halted with no distal perfusion. AKA, Adamkiewicz artery; SAP, segmental arterial pressure; SCBF, spinal cord blood flow; SCPP, spinal cord perfusion pressure. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 360-366DOI: (10.1016/j.jtcvs.2014.09.121) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Condition 1, no aortic clamp and no SA clamp (control group). A, Laboratory chart shows the real-time record of systemic blood pressure, distal arterial blood pressure, and SCBF. SCBF increases mildly relative to the increase in mSBP. B, Scattergram of percentage changes shows a weak positive correlation between mSBP and SCBF. DAP, Distal aortic blood pressure; mSBP, mean systemic blood pressure; NOA, norepinephrine; PAP, proximal arterial blood pressure; SBP, systemic blood pressure; SCBF, spinal cord blood flow. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 360-366DOI: (10.1016/j.jtcvs.2014.09.121) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Condition 2, aortic clamp (between L3 to L4 and L6 to L7) and L2, L3, and L7 SA clamps (L2-L7 SA flow halted) with distal perfusion. A, When inflow from the SAs is stopped, SCBF and SAP (SCPP) decrease; however, they increase as systemic blood pressure increases. B, Scattergram of percentage changes shows a positive correlation between mSBP and SCBF. C, Positive correlation is seen between SAP (SCPP) and SCBF. D, Positive correlation is seen between mSBP and SAP (SCPP). DAP, Distal arterial blood pressure; mSBP, mean systemic blood pressure; NOA, norepinephrine; PAP, proximal arterial blood pressure; SA, segmental artery; SAP, segmental arterial pressure; SBP, systemic blood pressure; SCBF, spinal cord blood flow; SCPP, spinal cord perfusion pressure. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 360-366DOI: (10.1016/j.jtcvs.2014.09.121) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Condition 3, aortic clamp (between L3 to L4 and L6 to L7) and L2, L3, and L7 SA clamps (L2-L7 SA flow halted) with no distal perfusion. A, When the distal bypass is clamped, SCBF and SAP (SCPP) decrease further; however, they then increase as systemic blood pressure increases. B, Scattergram of percentage changes shows a positive correlation between mSBP and SCBF. C, Positive correlation is seen between SAP (SCPP) and SCBF. D, Positive correlation is seen between mSBP and SAP (SCPP). DAP, Distal arterial blood pressure; mSBP, mean systemic blood pressure; NOA, norepinephrine; PAP, proximal arterial blood pressure; SAP, segmental arterial pressure; SBP, systemic blood pressure; SCBF, spinal cord blood flow; SCPP, spinal cord perfusion pressure. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 360-366DOI: (10.1016/j.jtcvs.2014.09.121) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions