Routine preoperative aortic computed tomography angiography is associated with reduced risk of stroke in coronary...

Area of Science:

• Cardiovascular Surgery
• Neuroradiology
• Medical Imaging

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
• Stroke is a significant complication following CABG.
• Atheromatous disease of the aorta is a known risk factor for stroke during cardiac surgery.

Purpose of the Study:

• To determine stroke rates in patients undergoing isolated CABG.
• To compare stroke incidence between patients who received routine computed tomography angiography (CTA) of the aorta and those who did not.
• To evaluate the impact of preoperative aortic CTA on in-hospital stroke risk.

Main Methods:

• Retrospective analysis of a prospectively maintained single-center registry (2009-2016).
• Inclusion of 2320 patients undergoing isolated CABG.
• Propensity score matching to create comparable cohorts (CTA vs. non-CTA) for analysis of in-hospital stroke.

Main Results:

• In 435 matched pairs, stroke occurred in 0.92% of the CTA cohort vs. 3.22% of the non-CTA cohort (P=0.017).
• Routine preoperative aortic CTA was associated with a 71% relative risk reduction in stroke (RR 0.29, P=0.026).
• Absolute risk reduction was 2.3% (P=0.017), with a number needed to treat of 44.

Conclusions:

• Preoperative screening for atheromatous aortic disease using CTA is linked to a lower stroke risk post-CABG.
• Routine use of aortic CTA can guide surgical decisions, enabling selective reduction or avoidance of ascending aorta manipulation.
• CTA facilitates personalized risk assessment and management in CABG patients.