Clinical impact of computerised tomographic angiography performed for preoperative evaluation before coronary artery bypass grafting

Park, Kay-Hyun; Lee, Hae Young; Lim, Cheong; Chung, Euy Hyun; Sung, Sook-Whan; Choi, Sang Il; Chun, Eun Ju

doi:10.1016/j.ejcts.2009.12.040

Cited by 30 publications

(26 citation statements)

References 24 publications

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“…Agreement of chest X-ray and ultralow-dose with standard-dose CT regarding extent of thoracic atherosclerotic burden Stroke after cardiac surgery is a feared complication with still relatively high incidence 1 and recent studies have reported that pre-operative visualization of the thoracic aorta by CT may reduce stroke risk. 11 Several studies found a decrease in post-operative stroke rates from 3.0 to 0.7% 22 and from 9.0 to 0.4%, 23 respectively of patients undergoing pre-operative CT compared with a control group without pre-operative imaging. The investigators reported a change in surgical approach mainly with respect to different cannulation site selection and the use of an off-pump no-touch operation technique.…”

Section: Discussionmentioning

confidence: 99%

“…The investigators reported a change in surgical approach mainly with respect to different cannulation site selection and the use of an off-pump no-touch operation technique. 22,23 Currently, pre-operative CT is not routinely performed prior to cardiac surgery also owing to relatively high radiation exposure of CT with the potential risk of radiation-induced malignancy. Standard pre-operative work-up before cardiac surgery includes evaluation by chest X-ray, however, it was reported that plain X-ray only detects large calcified areas and generally underestimates thoracic aortic atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

Messerli

Giannopoulos

Leschka

et al. 2017

BJR

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A reliable estimation of calcified atherosclerotic burden of the thoracic aorta can be achieved with modern tin-filter CT at dose values comparable to chest direct radiography. Advances in knowledge: Our findings suggest that ultralow-dose CT is an excellent tool for assessing the calcified atherosclerotic burden of the thoracic aorta with higher diagnostic accuracy than conventional chest radiography and importantly without the additional cost of increased radiation dose.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

Messerli

Giannopoulos

Leschka

et al. 2017

BJR

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show abstract

“…A study by Park et al (2010) recommends preoperative CT angiography to be used as a routine test before CABG, unless contraindicated. More studies are needed to replicate this contention [17]. …”

Section: Discussionmentioning

confidence: 99%

Increasing Severity of Aortic Atherosclerosis in Coronary Artery Bypass Grafting Patients Evaluated by Transesophageal Echocardiography

et al. 2015

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BackgroundAtherosclerotic disease in coronary artery bypass grafting (CABG) patients is a potential contributor to complications in the perioperative periods. This study was undertaken to better define how the frequency of aortic atheromatous disease among patients coming for CABG has evolved over the last decade.MethodsData from elective patients coming for CABG who underwent transesophageal echocardiography (TEE) examinations following induction of anesthesia were obtained for the years 2002 and 2009. Aortas were graded according to the method of Kronzon, with the following interpretations: normal = grade I, intimal thickening = 2, atheroma of less than 5 mm = 3, atheroma of > 5 mm = 4, and any mobile atheroma = 5. The data of 124 patients who underwent comprehensive exam of the aorta by one cardiac anesthesiologist were gathered and assigned into two groups based on the year TEE was done. Student’s t-test was used for statistical analysis. A P value < 0.05 was considered significant. The data were presented as mean ± SD.ResultsThere was significant difference between group 2002 (2.05 ± 1.28) and group 2009 (2.59 ± 1.11) in atheroma grade (P = 0.013).ConclusionsPatients coming for CABG in group 2009 exhibited significantly higher grades of aortic atheroma on TEE, compared to group 2002. Understanding the risk of atheroma in the elderly CABG population may help in altering surgical approaches to lessen the risk of catastrophic stroke. Potential options needing further study include the off-pump approach and modification of cross-clamp site and technique as well as other modalities.

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“…Preoperative 64-slice multidetector CT scan has been used in CABG patients to evaluate the incidence of pathologic lesions of the aorta and its major branches. The finding of significant atherosclerosis can offer the opportunity to modify risk assessment, CABG procedure itself, perioperative management or follow-up plan in about half of patients [ 56 ] . Surgical removal or endovascular isolation of the source of emboli could offer a definitive treatment option.…”

Section: Managementmentioning

confidence: 99%

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

et al. 2017

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Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.

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Clinical impact of computerised tomographic angiography performed for preoperative evaluation before coronary artery bypass grafting

Abstract: Because preoperative CT angiography considerably affected management in one half of patients, we recommend its use as a routine test before CABG, unless contraindicated.

Cited by 30 publications

References 24 publications

Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta

Increasing Severity of Aortic Atherosclerosis in Coronary Artery Bypass Grafting Patients Evaluated by Transesophageal Echocardiography

Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features

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