Document Detail


Stroke risk after coronary artery bypass graft surgery and extent of cerebral artery atherosclerosis.
MedLine Citation:
PMID:  21527154     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We aimed to define the relationship between cerebral atherosclerosis and stroke after coronary artery bypass grafting (CABG).
BACKGROUND: Although cerebral atherosclerosis may play a crucial role in the advent of post-CABG stroke, only extracranial carotid artery disease has been extensively studied, and the effects of atherosclerosis on the mechanisms underlying post-CABG stroke remain unclear.
METHODS: Pre-operative magnetic resonance angiography was performed on 1,367 consecutive CABG patients to assess intracranial and extracranial cerebral atherosclerosis. Disease severity was evaluated by atherosclerosis score, as determined by the number of steno-occlusions of cerebral arteries and the degree thereof. Post-CABG strokes (within 14 days) were classified as atherosclerotic (strokes attributable to pre-defined atherosclerosis) or other (strokes caused by other mechanisms). Associations between post-CABG stroke and each type of atherosclerotic disease (extracranial carotid artery disease, intracranial, extracranial, or extracranial and/or intracranial cerebral atherosclerosis), differentiated according to the involved arteries, were analyzed.
RESULTS: Stroke occurred in 33 patients, and the atherosclerosis score was independently associated with stroke development (odds ratio: 1.35; 95% confidence interval: 1.16 to 1.56). Atherosclerotic stroke was defined in 15 (45%), and constituted >40% of both immediate (within 24 h) and delayed strokes. Intracranial, extracranial, and extracranial and/or intracranial cerebral atherosclerosis were significantly associated with stroke.
CONCLUSIONS: Cerebral atherosclerosis was closely related to the occurrence of post-CABG stroke, being both an independent risk factor for and the cause of a significant proportion of strokes. Pre-operative evaluation of intracranial and extracranial cerebral arteries, apart from the extracranial carotid artery, may be useful to predict the likelihood of post-CABG stroke.
Authors:
Eun-Jae Lee; Kyoung-Hyo Choi; Ju-Seok Ryu; Sang-Beom Jeon; Seung-Whan Lee; Seong-Wook Park; Seung-Jung Park; Jae-Won Lee; Suk-Jung Choo; Cheol-Hyun Chung; Sung-Ho Jung; Dong-Wha Kang; Jong S Kim; Sun U Kwon
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  57     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-29     Completed Date:  2011-07-26     Revised Date:  2012-01-11    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1811-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Atrial Fibrillation / epidemiology
Coronary Artery Bypass / adverse effects*
Female
Humans
Intracranial Arteriosclerosis / epidemiology,  pathology*
Logistic Models
Magnetic Resonance Angiography*
Male
Middle Aged
Preoperative Care*
Registries
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Stroke / epidemiology*
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2011 Dec 6;58(24):2545-6; author reply 2546   [PMID:  22133858 ]
J Am Coll Cardiol. 2011 May 3;57(18):1819-21   [PMID:  21527155 ]

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