Brain magnetic resonance imaging in coronary artery bypass grafts

Schmidt, Reinhold; Fazekas, F.; Offenbacher, H.; Mächler, Heinrich; Freidl, Wolfgang; Payer, F.; Rigler, B; Harrison, Melissa; Lechner, H

doi:10.1212/wnl.43.4.775

Cited by 51 publications

(19 citation statements)

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“…We detected lacunar infarcts on MR images in 86 (57.0%) of our 151 subjects. Our finding of frequent association of lacunar infarcts in CABG candidates is comparable with those reported in studies of Goto et al [25](54%) and Schmidt et al [30](58%). We previously found that carotid stenosis and ischemic heart disease were predictors of silent cerebral infarcts in the basal ganglia, and suggested that these were manifestations of the progression of generalized atherosclerosis [31].…”

Section: Discussionsupporting

confidence: 92%

MR Angiographic Evaluation of Carotid and Intracranial Arteries in Japanese Patients Scheduled for Coronary Artery Bypass Grafting

Uehara¹,

Tabuchi²,

Kozawa

et al. 2001

Cerebrovasc Dis

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Background and Purpose: Stroke is a serious complication of coronary artery bypass grafting (CABG). Preoperative evaluation of the cerebral arteries to identify patients at increased risk of stroke after CABG is important. In a prospective study, we evaluated cerebral artery occlusive lesions with MR angiography in Japanese patients scheduled to undergo CABG to determine the prevalence of occlusive diseases in the extracranial carotid and intracranial arteries in this population and to identify preoperative risk factors for these patients. Methods: The subjects were 151 consecutive patients (115 men and 36 women ranging in age from 41 to 82 years) who were scheduled for CABG under nonemergency conditions between October 1995 and February 1998. Carotid and intracranial arteries were examined for occlusive lesions with MR angiography. Patient demographics and risk factors including age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking habit, history of stroke, peripheral vascular disease and preoperative thromboembolic infarcts revealed by MR imaging were recorded and analyzed. Results: Cervical carotid artery stenoses of more than 50% narrowing were detected in 16.6% of the subjects, and intracranial artery stenoses of more than 50% narrowing were detected in 21.2% of the subjects. Multiple logistic regression analyses identified peripheral vascular disease and lacunar infarcts in the basal ganglia as significant and independent predictors of cervical carotid arterial stenoses. No significant predictor for intracranial arterial stenoses was identified. Conclusions: The prevalence of extracranial carotid and intracranial artery stenosis in Japanese patients scheduled for CABG is considerably high. MR angiography is of value of identifying these patients. Preoperative evaluation of cranial arteries is recommended, particularly in patients with peripheral vascular disease and infarcts in the basal ganglia.

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Section: Discussionsupporting

confidence: 92%

MR Angiographic Evaluation of Carotid and Intracranial Arteries in Japanese Patients Scheduled for Coronary Artery Bypass Grafting

Uehara¹,

Tabuchi²,

Kozawa

et al. 2001

Cerebrovasc Dis

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“…neuropsychological deficits in a small patient group, Schmidt et al 49 failed to demonstrate CABG-related microembolic lesions on postoperative MRIs. We also did not find a correlation between neuropsychological deficits and the HITS-induced changes of rCMRGlc deltamax , which might have two reasons.…”

Section: Discussionmentioning

confidence: 96%

Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events

Jacobs

Neveling

Horst

et al. 1998

Stroke

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Background and Purpose-High-intensity transient signals (HITS) during cardiac surgery are capable of causing encephalopathy and cognitive deficits. This study was undertaken to determine whether intraoperative HITS cause alterations of neuropsychological function (NPF) and/or cerebral glucose metabolism (CMRGlc), even in a low-risk patient group, and whether induced changes are interrelated. Methods-Eighteen patients without signs of cerebrovascular disease underwent elective coronary artery bypass grafting (CABG), and two of these additionally underwent valve replacement in normothermia. Intraoperatively, HITS were recorded by means of transcranial Doppler ultrasonography (TCD). Perioperatively, NPF and CMRGlc were assessed using a standardized complex test battery and positron emission tomography with 18 F-2-fluoro-2-deoxy-D-glucose (FDG-PET), respectively. Results-Intraoperatively, the number of HITS ranged from 90 to 1710 per patient and hemisphere, more on the right side than on the left (PϽ.05). HITS occurred primarily during cardiopulmonary bypass (71.3%) and, to a lesser extent, during aortic manipulation (22.2%). Changes in global and regional CMRGlc between first (one day preoperatively) and second (8 to 12 days postoperatively) FDG-PET scans were mild. No correlations were found between the number of HITS, age of patient, duration of cardiac ischemia or cardiopulmonary bypass and the changes in CMRGlc. In patients with recorded HITS and a postoperative decrease of regional CMRGlc (nϭ11), the maximal decrease of rCMRGlc in each hemisphere below the individual global change of CMRGlc correlated with the number of HITS (rϭϪ0.46, PϽ.05). Limitations in NPF occurred 8 to 12 days postoperatively, resolved within 3 months, and were not found to be correlated to the absolute number of HITS or changes in CMRGlc. Conclusions-HITS during cardiac surgery can cause alterations of both NPF and CMRGlc, even in a low-risk patient group.However, the number of HITS and changes in NPF and CMRGlc are not necessarily interrelated, which indicates that (1) the location of brain damage related to HITS is more important for the development of NPF than is the absolute number of HITS, and (2) factors in addition to HITS might contribute to surgery-related brain damage. (Stroke. 1998;29:660-667.)

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“…35 Only 2 previous studies have examined control subjects who did not undergo CABG. 15,33 Other limitations of previous reports include the use of low-field-strength scanners (0.15 DWI of a 64-year-old woman (patient 2, Table 1) without any demonstrable neurological deficits after CABG. Preoperative scan, performed 2 days after a diagnostic cardiac catheterization, revealed a small diffusion abnormality on the right corona radiata.…”

Section: Discussionmentioning

confidence: 99%

Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging of the Brain Before and After Coronary Artery Bypass Grafting Surgery

Restrepo

Wityk

Grega

et al. 2002

Stroke

163

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Background and Purpose-Coronary artery bypass grafting (CABG) is a frequently performed surgical procedure that can be associated with neurological complications. Some studies have demonstrated that new focal brain lesions, detected by MRI, can develop after CABG. Furthermore, it has been suggested that the presence of such new lesions is associated with a decline in neurocognitive test scores. Advanced MRI techniques, including diffusion-(DWI) and perfusionweighted imaging (PWI), offer important diagnostic advantages over conventional imaging in the assessment of patients undergoing CABG. We sought to determine whether focal PWI and DWI abnormalities could occur after CABG, particularly in patients without any measurable neurological deterioration. Methods-Thirteen patients prospectively underwent MRI with DWI and PWI before and after CABG. A battery of neurocognitive tests was administered before and after surgery. Demographic, clinical, and radiographic characteristics of the patients were collected and compared. Results-Four patients developed new DWI defects after CABG. The lesions were small, rounded, and multiple (3 of 4 patients). One of these patients was diagnosed with stroke on clinical grounds.

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Brain magnetic resonance imaging in coronary artery bypass grafts

Cited by 51 publications

References 0 publications

MR Angiographic Evaluation of Carotid and Intracranial Arteries in Japanese Patients Scheduled for Coronary Artery Bypass Grafting

MR Angiographic Evaluation of Carotid and Intracranial Arteries in Japanese Patients Scheduled for Coronary Artery Bypass Grafting

Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events

Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging of the Brain Before and After Coronary Artery Bypass Grafting Surgery

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