HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Masanori Nakamura Akira Yamada Keisuke Sakai Tetsuya Higami Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nakamura, M. Articles by Higami, T. Search for Related Content PubMed Articles by Nakamura, M. Articles by Higami, T. Related Collections Cerebral protection Coronary disease Related Article

---

Original Articles: Cardiovascular

Does Intensive Management of Cerebral Hemodynamics and Atheromatous Aorta Reduce Stroke After Coronary Artery Surgery?

^a Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Hokkaido, Japan
^b Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
^c Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
^d Department of Neurosurgery, Hokkaido University Hospital, Sapporo, Hokkaido, Japan

Accepted for publication August 27, 2007.

^_* Address correspondence to Dr Nakamura, Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan (Email: masanori{at}sapmed.ac.jp).

Background: Atheromatous aorta and carotid artery disease are known predictors for stroke after coronary artery bypass grafting (CABG). The clinical significance of intracranial cerebral artery disease is not known. This study was designed to determine whether a therapeutic strategy based on perioperative detection of intracranial and extracranial occlusive cerebrovascular disease and atheromatous aorta could reduce perioperative stroke.

Methods: We studied 485 patients who underwent isolated CABG. The control group was 247 patients who underwent standard-protocol CABG. The 238 subjects in the intervention group underwent preoperative magnetic resonance angiography of the head and neck and intraoperative epiaortic scanning. Cerebral hemodynamics were evaluated by single photon emission computed tomography and acetazolamide tests in patients with significant occlusive cerebrovascular disease. Surgical outcomes were compared.

Results: In the intervention group, magnetic resonance angiography detected significant intracranial or extracranial occlusive cerebrovascular disease, or both, in 40 patients. Prophylactic cerebrovascular interventions were performed in 7 patients who had disturbed cerebral hemodynamics. Aorta no-touch off-pump coronary artery bypass (OPCAB) was chosen intraoperatively in 37 patients with moderate to severe atheromatous aorta. The in-hospital stroke rate was 0.42% in the intervention group vs 2.8% in the control group (p = .068). A multivariate analysis revealed that the perioperative interventional protocol was the most powerful predictor of reduced risk of perioperative stroke (odds ratio, 0.023; 95% confidence interval, 0.001 to 0.469).

Conclusions: Prophylactic cerebrovascular interventions and the selective use of aorta no-touch OPCAB can significantly reduce the incidence of perioperative stroke. Careful vascular evaluation before and during CABG can improve surgical outcomes.

Related Article

Invited Commentary

Antonio Calafiore
Ann. Thorac. Surg. 2008 85: 519. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				A. Calafiore Invited Commentary Ann. Thorac. Surg., February 1, 2008; 85(2): 519 - 519. [Full Text] [PDF]