Changes in cerebral oxygenation during hemodialysis before and after carotid artery stenting

Hisashi Sato, MD; Susumu Ookawara, MD, PhD; Kiyonori Ito, MD, PhD; Yuichiro Ueda, MD; Keiji Hirai, MD, PhD; Yoshikazu Yoshino, MD, PhD; Yoshiyuki Morishita, MD, PhD

Radiology Case Reports (Aug 2022)

Changes in cerebral oxygenation during hemodialysis before and after carotid artery stenting

Hisashi Sato, MD,
Susumu Ookawara, MD, PhD,
Kiyonori Ito, MD, PhD,
Yuichiro Ueda, MD,
Keiji Hirai, MD, PhD,
Yoshikazu Yoshino, MD, PhD,
Yoshiyuki Morishita, MD, PhD

Affiliations

Hisashi Sato, MD: Division of General Medicine, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Susumu Ookawara, MD, PhD: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan; Corresponding author.
Kiyonori Ito, MD, PhD: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Yuichiro Ueda, MD: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Keiji Hirai, MD, PhD: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Yoshikazu Yoshino, MD, PhD: Department of Endovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Yoshiyuki Morishita, MD, PhD: Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan

Journal volume & issue: Vol. 17, no. 8
pp. 2589 – 2593

Abstract

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A 68-year-old man received hemodialysis (HD) for the treatment of end-stage renal failure for 6 years. Five years prior to carotid artery stenting (CAS), a neck ultrasound performed to screen for carotid atherosclerosis revealed an asymptomatic right internal carotid artery stenosis. One month prior, the stenotic lesion progressed to 74% by cerebral angiography; therefore, CAS was performed. To evaluate the influence of right internal carotid artery stenosis on the intradialytic cerebral circulation and oxygenation, cerebral regional oxygen saturation (rSO2) at bilateral forehead was measured using the INVOS 5100c oxygen saturation monitor (Covidien Japan, Japan) during HD before and after CAS. Before CAS, right cerebral rSO2 was maintained during HD, whereas left cerebral rSO2 gradually increased from the initiation to end of HD. However, the differences of intradialytic cerebral rSO2 changes between bilateral sides disappeared after CAS. In the present case, before CAS, the intradialytic increase in left cerebral rSO2 might reflect the increase in the left cerebral blood flow to compensate for the ultrafiltration-associated decreases in the right cerebral blood flow and perfusion pressure. Furthermore, the preserved right cerebral rSO2 before CAS might reflect the mechanism maintaining the right cerebral blood flow from the collateralized circle of Willis during HD. Throughout our experience, cerebral oxygenation monitoring during HD might disclose intradialytic changes in cerebral blood flow distribution between the ipsilateral and contralateral side in HD patients with carotid artery stenosis.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: http://www.journals.elsevier.com/radiology-case-reports/

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