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Ann Thorac Surg 2000;70:1565-1570
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Thickened intima of the aortic arch is a risk factor for stroke with coronary artery bypass grafting

Tomohiro Mizuno, MDa, Masaaki Toyama, MDa, Noriyuki Tabuchi, MD, PhDa, Kazuyuki Kuriu, MDa, Shigeyuki Ozaki, MDa, Isamu Kawase, MDb, Hirotsugu Horimi, MDb

a Department of Cardiovascular Surgery, Kameda Medical Center, Chiba, Japan
b Department of Cardiovascular Surgery, Tokyo Takanawa Hospital, Tokyo, Japan

Address reprint requests to Dr Mizuno, Department of Cardiovascular Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan

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.




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