Table 3. Advantages and limitations of each cerebral protection strategy [reprinted with permission from Stein et al. (17)].

Technique	Advantage	Limitation	Comment
DHCA	Safe for short periods of circulatory arrest Avoids cross-clamping an already diseased aorta	Questions of safety for long periods of circulatory arrest; increased incidence of permanent neurologic injury with >45 mins of circulatory arrest; conflicting data on transient effects with shorter (approximately 25 mins) ischemia	Generally used in more straightforward cases
ACP	Permits longer periods of circulatory arrest than with straight DHCA	Requires the handling of sclerotic vessels; may result in the release of emboli	Technique most often used. Controversies regarding ideal site of cannulation for optimal perfusion
RCP	Flushes cerebral vasculature of toxic metabolic products and microemboli	Perfusion may be limited to the brain’s surface	Becoming less popular