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Published on: March 27, 2018
Magnetic resonance angiography in coronary artery bypass grafting
Shingo Ohuchi1, Kohei Kawazoe, Hiroshi Izumoto
1Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center Morioka, Japan. gekai_ohuchi@hotmail.com
Insights
This study reduced perioperative stroke incidence in coronary artery bypass grafting patients by using head and neck magnetic resonance angiography to detect cerebrovascular disease and guide surgical technique selection.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Radiology
Background:
- Coronary artery bypass grafting (CABG) carries a risk of perioperative stroke.
- Cerebrovascular disease is a significant risk factor for stroke in CABG patients.
Purpose of the Study:
- To reduce the incidence of perioperative stroke in patients undergoing CABG.
- To evaluate the effectiveness of preoperative head and neck magnetic resonance angiography (MRA) in identifying cerebrovascular disease.
- To assess the impact of selecting specific CABG techniques based on MRA findings on stroke prevention.
Main Methods:
- Preoperative head and neck MRA was performed in 268 patients with ischemic heart disease before elective CABG.
- Patients with significant stenosis or obstruction on MRA underwent further evaluation, including brain single-photon emission computed tomography (SPECT) to assess cerebral blood flow.
- Off-pump CABG was utilized in high-risk patients to maintain cerebral blood flow.
Main Results:
- No intraoperative strokes occurred in any of the 268 patients.
- Hemodynamic cerebrovascular ischemia was prevented during surgery for all patients.
- The overall incidence of postoperative stroke was 1.1% (3 patients), indicating a reduction in perioperative stroke.
Conclusions:
- Preoperative head and neck MRA is effective in detecting cerebrovascular disease prior to CABG.
- Tailoring CABG technique based on MRA findings can significantly reduce perioperative stroke risk.
- This integrated strategy enhances patient safety during coronary artery bypass grafting.
Abstract:
An attempt was made to reduce the incidence of perioperative stroke by detecting cerebrovascular disease with preoperative head and neck magnetic resonance angiography and by selecting the coronary artery bypass grafting technique. This strategy was used in 268 patients with ischemic heart disease who had undergone both head and neck magnetic resonance angiography before elective coronary artery bypass in our hospital between May 1997 and April 2001. In patients with significant stenosis or obstruction detected by head and neck magnetic resonance angiography, the findings were evaluated and cerebral blood flow was examined using brain single-photon emission computed tomography. In those with a high risk of cerebrovascular ischemia, off-pump coronary artery bypass was performed to maintain cerebral blood flow. No stroke occurred during surgery, and hemodynamic cerebrovascular ischemia was prevented in all 268 patients. Postoperative stroke occurred in 3 patients (1.1%), but the incidence of perioperative stroke was reduced.
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