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Thickened intima of the aortic arch is a risk factor for stroke with coronary artery bypass grafting
T Mizuno1, M Toyama, N Tabuchi
1Department of Cardiovascular Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan.
Insights
Aortic arch intima thickness exceeding 5 mm significantly increases stroke risk in coronary artery bypass grafting (CABG) patients. Careful evaluation is crucial for preventing perioperative stroke complications.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Medicine
Background:
- Perioperative stroke is a critical complication following cardiac surgery.
- Aortic atherosclerosis severity is linked to stroke risk in these patients.
Purpose of the Study:
- To assess the correlation between thoracic aortic intimal thickness and stroke risk in coronary artery bypass grafting (CABG) patients.
- To identify intimal thickness thresholds predictive of perioperative stroke.
Main Methods:
- Transesophageal echocardiography was used to measure intimal thickness of the thoracic aorta.
- 315 patients undergoing isolated CABG with cardiopulmonary bypass were studied.
- Intimal thickness was correlated with the incidence of perioperative stroke.
Main Results:
- Five patients (1.6%) experienced perioperative stroke or systemic emboli.
- Mean intimal thickness at the aortic arch was significantly greater in stroke patients (6.94 mm) compared to non-stroke patients (2.78 mm).
- An aortic arch intima thickness >5 mm was associated with a significantly higher incidence of perioperative stroke (p=0.007).
Conclusions:
- Aortic arch intima thickness >5 mm indicates a high risk for perioperative stroke in CABG patients.
- Preoperative assessment of aortic intimal thickness can aid in risk stratification.
- Careful consideration of the CABG procedure is warranted for patients with thickened aortic intima to mitigate stroke risk.
Background:
Perioperative stroke is one of the most serious complications of cardiac surgery.
Methods:
Using transesophageal echocardiography, we estimated the intimal thickness of the thoracic aorta as an index of the severity of aortic atherosclerosis to determine the risk of stroke in coronary artery bypass grafting (CABG) patients. The study population comprised 315 consecutive patients who underwent isolated CABG with cardiopulmonary bypass.
Results:
Five patients (1.6%) had perioperative cerebral stroke or systemic emboli. We compared the mean intimal thicknesses of the ascending aorta, aortic arch, and descending aorta. Mean thicknesses in patients without stroke were 2.07 +/- 0.76, 2.78 +/- 1.15, and 2.32 +/- 1.21 mm, respectively, and mean thicknesses in the stroke patients were 1.94 +/- 0.55, 6.94 +/- 3.79, and 3.39 +/- 1.85 mm, respectively. The patients with an intima of more than 5 mm at the aortic arch had a significantly greater incidence of perioperative stroke (p = 0.007).
Conclusions:
These results suggest that patients who have an aortic arch intima thickened to more than 5 mm are at a significantly high risk for perioperative stroke, and thus, the CABG procedure should be carefully evaluated to prevent such complications.