Embolic Signals And Prediction of Ipsilateral Stroke or Transient Ischemic Attack in Asymptomatic Carotid Stenosis

Abbott, Anne L.; Chambers, Brian R.; Stork, Jacinda L.; Levi, Christopher; Bladin, Christopher; Donnan, Geoffrey A.

doi:10.1161/01.str.0000166059.30464.0a

Cited by 135 publications

(98 citation statements)

References 22 publications

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“…13 Embolic signals measured using TCD were even observed in patients with asymptomatic carotid artery stenosis, resulting in silent cerebral infarction. 14,15 Significant atherosclerosis, manifesting as carotid stenosis or ascending aortic plaque, was also associated with delirium after CABG. 16 Therefore, evaluation of carotid artery stenosis and ascending aortic plaque to identify its relation to both postoperative delirium and new magnetic resonance imaging (MRI)-detectable ischemic lesions may provide important information on the pathophysiology of these neurological abnormalities.…”

Section: Résumémentioning

confidence: 99%

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Omiya

Yoshitani

Yamada

et al. 2015

Can J Anesth/J Can Anesth

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Background Delirium after cardiac surgery is a serious complication, increasing morbidity and mortality. Despite its high expectations, off-pump coronary artery bypass grafting (OPCAB) has largely failed to reduce the incidence of postoperative neurological complications. To further investigate the reasons for this failure, we used perioperative brain magnetic resonance imaging (MRI) to determine the relation between MRI findings and postoperative delirium. Methods Altogether, 98 patients undergoing elective OPCAB were enrolled in this prospective observational study. Patients underwent brain MRI and magnetic resonance angiography (MRA) before and after surgery to identify cerebral infarction, white matter lesions, and intracranial artery stenosis. Postoperative delirium in the intensive care unit was measured using the delirium rating scale. The relation between postoperative delirium and MRI findings was examined using logistic regression. Results Magnetic resonance imaging and MRA was completed in 88 (90%) of the patients. New ischemic lesions were present in seven (7.9%) patients. Delirium rating scale scores of 0, 1-7, and C 8 were found in 25 (31%), 48 (60%), and seven (9%) patients, respectively. Multivariate logistic regression analysis revealed that new ischemic lesions (odds ratio [OR] 11.07, 95% confidence interval [CI]: 1.53 to 80.03; P = 0.017), carotid artery stenosis (OR 7.06, 95% CI: 1.59 to 31.13; P = 0.010), history of myocardial infarction (OR 3.78, 95% CI: 1.05 to 13.65; P = 0.043), and deep subcortical white matter hyperintensity (OR 3.04, 95% CI: 1.14 to 8.12; P = 0.027) were significantly associated with postoperative delirium. Conclusions Magnetic resonance imaging findings of new cerebral ischemic lesions, carotid stenosis, and deep subcortical white matter hyperintensity correlated significantly with postoperative delirium in patients who had undergone OPCAB surgery.Author contributions Hiroki Omiya was involved in patient recruitment and writing the manuscript. Kenji Yoshitani was involved in patient recruitment and data collection. Naoki Yamada was involved in review of the brain magnetic resonance images. Yosuke Kubota was involved in patient recruitment and data collection. Kanae Takahashi was involved in study design and data analysis. Junjiro Kobayashi assisted with editing of the manuscript, particularly for the surgical procedure. Yoshihiko Ohnishi was involved in overall supervision and management of the study. 123Can J Anesth/J Can Anesth (2015) 62:595-602 DOI 10.1007/s12630-015-0327-x Résumé Contexte La survenue d'un délirium après chirurgie cardiaque est une complication grave, augmentant la morbidité et la mortalité. En dépit des fortes attentes, le pontage coronarien à coeur battant (OPCAB) a largement échoué à démontrer qu'il pouvait réduire l'incidence des complications neurologiques postopératoires. Pour approfondir l'étude des raisons de cet échec, nous avons utilisé une imagerie par résonance magnétique (IRM) périopératoire du cerveau pour déterminer la rela...

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Section: Résumémentioning

confidence: 99%

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Omiya

Yoshitani

Yamada

et al. 2015

Can J Anesth/J Can Anesth

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“…Patienten mit asymptomatischer Stenose ohne MES haben ein sehr geringes Risiko in der nächsten Zeit (<1%/Jahr) ein zerebrovaskuläres Ereignis zu erleiden [75]. In einer Studie mit 202 Patienten zeigte sich bei vorhandenen MES ein nicht signifikanter Trend für ein höheres Risiko im Zeitraum von 6 Monaten, einen Schlaganfall oder TIA zu erleiden (OR 1,4; 95%-KI 0,43-4,48) [71]. In der Studie von Spence et al [75] war das Risiko im ersten Jahr nach MES-Detektion signifikant höher, eine TIA (OR 10,1; Der einzige weitere unabhängige Risiko faktor war in dieser Kohorte das weibliche Geschlecht (OR 9,8; 95%-KI 2,2-43,4).…”

Section: Methodenkritikunclassified

S3-Leitlinie Extracranielle Carotisstenose

et al. 2012

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“…There were methodological issues with patient selection [5][6][7][8] . Whilst unlikely to skew the data it should be taken into account when interpreting results.…”

Section: Quality Of Evidencementioning

confidence: 99%

Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

Best¹,

Webb

Gurusamy³

et al. 2016

European Journal of Vascular and Endovascular Surgery

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Embolic Signals And Prediction of Ipsilateral Stroke or Transient Ischemic Attack in Asymptomatic Carotid Stenosis

Abstract: Although there were more ipsilateral carotid cerebrovascular events among ES-positive arteries, this was not statistically significant. Less labor-intensive techniques are required to make further study and clinical application practical.

Cited by 135 publications

References 22 publications

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

Imagerie préopératoire par résonance magnétique du cerveau et délirium postopératoire après pontage coronarien à cœur battant: une étude prospective de cohorte

S3-Leitlinie Extracranielle Carotisstenose

Transcranial Doppler Ultrasound Detection of Microemboli as a Predictor of Cerebral Events in Patients with Symptomatic and Asymptomatic Carotid Disease: A Systematic Review and Meta-Analysis

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