Does preoperative screening with computed tomography of the chest decrease risk of stroke in patients undergoing...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Radiology

Background:

• Coronary artery bypass grafting (CABG) carries a risk of embolic stroke, often linked to aortic calcifications.
• Aortic calcification is a common source of emboli causing stroke post-CABG.
• Identifying pre-operative risk factors for stroke is crucial in CABG patients.

Purpose of the Study:

• To evaluate the clinical utility of routine preoperative chest computed tomography (CT) for screening aortic calcification.
• To determine the impact of aortic calcification screening on the incidence of postoperative stroke in CABG patients.

Main Methods:

• Retrospective case-control study of 405 patients undergoing primary isolated CABG.
• Preoperative plain chest CT used to screen for aortic calcification, categorized by location and pattern.
• Comparison of aortic calcification distribution between patients with and without postoperative stroke.
• Univariate and multivariate regression analysis to identify stroke predictors.

Main Results:

• Postoperative stroke occurred in 3.5% of patients.
• A history of preoperative stroke or transient ischemic attack (TIA) was the sole significant predictor of postoperative stroke (P<0.001).
• While higher in stroke patients, aortic calcification (aortic root, ascending, descending) did not reach statistical significance as a predictor.

Conclusions:

• Preoperative chest CT effectively detects aortic calcification in CABG patients.
• The routine use of chest CT for aortic calcification screening did not demonstrate a significant impact on preventing postoperative stroke in this study.
• Further prospective studies are needed to investigate the impact of aortic calcification screening on stroke prevention.