Ultrasonic plaque density of aortic atheroma and stroke in patients undergoing on-pump coronary bypass surgery
Hideaki Nohara1, Tsutomu Shida, Nobuhiko Mukohara
1Department of Surgery, Hyogo Prefectural Kaibara Hospital, Hyogo, Japan.
Insights
Aortic plaque echo density, measured by gray scale median (GSM), predicts stroke risk after on-pump coronary artery bypass grafting (CABG). Lower GSM values indicate higher stroke and embolic event incidence, aiding patient selection.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Postoperative stroke and embolic events are significant complications.
- Aortic atheromatous plaque is a potential source of emboli.
Purpose of the Study:
- To investigate the relationship between aortic atheromatous plaque echo density and postoperative stroke or embolic events.
- To assess the utility of transesophageal echocardiography (TEE) in predicting these events after on-pump CABG.
Main Methods:
- 314 patients undergoing on-pump CABG were analyzed.
- Aortic plaque images were obtained via TEE.
- Plaque echo density was quantified using gray scale median (GSM) from pixel histogram analysis.
Main Results:
- Patients with postoperative stroke/embolism had significantly lower plaque GSM (90.6±21.3) compared to those without (151.0±38.2).
- Stroke/embolism incidence was 58.3% for plaque GSM < 100 versus 3.6% for GSM > 100 (p<0.001).
Conclusions:
- Computer analysis of aortic plaque echo density (GSM) is valuable for risk stratification.
- Identifying high-risk patients undergoing on-pump CABG can help reduce postoperative stroke and embolic events.
Objective:
The purpose of this study was to determine the relationship between the aortic atheromatous plaque echo density and the incidence of postoperative stroke or embolic events in patients undergoing on-pump coronary artery bypass grafting (CABG).
Patients And Methods:
Three hundred and fourteen patients who received on-pump CABG alone were studied. Images of the aortic plaques obtained using transesophageal echocardiography were transferred to a computer. Using an image analysis program, a histogram for plaques more than 3 mm in thickness was obtained through the gray tone frequency distribution of the pixels (0-225). The gray scale median (GSM) was used as a measure of plaque echo density.
Results:
Fifty-eight plaques in patients not associated with postoperative stroke or embolic events had GSM ranging from 58 to 241 (151.0+/-38.2), while 9 plaques in patients associated with stroke or embolic events had GSM ranging from 67 to 130 (90.6+/-21.3, p<0.001). The incidence of stroke or embolism was 58.3% when GSM of plaque was less than 100, while it was 3.6% when plaque GSM was more than 100 (p<0.001).
Conclusion:
This study indicated that computer analysis of aortic atheromatous plaque was useful for selecting patients who had a high risk of postoperative stroke or embolism when receiving on-pump CABG, and for decreasing the incidence of them.
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