Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting

Ito, Asuka; Gotō, Tomoko; Maekawa, Kengo; Baba, Tomoko; Mishima, Yasuo; Ushijima, Kazuo

doi:10.1007/s00540-012-1327-4

Cited by 32 publications

(19 citation statements)

References 27 publications

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“…Yoon et al [10] found that 16.4% of the patients undergoing nonemergency isolated CABG had intracranial artery disease alone, and 13.9% had extra-and intracranial artery disease. Ito et al [26] found that almost half (49.9%) of the patients who underwent CABG had silent (35.2%) or symptomatic (14.7%) brain infarction. In our study, brain MRI with DWI and MRA findings revealed that 61.8% of the patients who underwent OPCABG had prior cerebral infarction, and 32.7% had intracranial artery disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

et al. 2014

Neurophysiology

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We tried to determine whether postoperative CNS complications after off-pump coronary artery bypass grafting (OPCABG) are related to prior cerebral infarction or intracranial artery disease. Fiftyfive patients (among them, 40 men; mean age 64.6 ± 8.9 years) subjected to OPCABG underwent neurological and neuropsychological examinations 24 h before surgery. MRI was used to identify old and/or new ischemic lesions before surgery, and MRA was used to determine the presence and severity of intracranial artery disease. The patients were examined eight days after surgery; possible development of stroke or cognitive dysfunction was evaluated. Associations between postoperative stroke and potential predictors, including prior cerebral infarction and intracranial artery disease, were analyzed using univariate methods. Two of 55 (3.64%) patients had postoperative stroke, and no patient showed cognitive decline. Univariate analysis found no significant association between postoperative stroke and prior cerebral infarction detected by MRI (P = 0.378) or intracranial artery disease detected by MRA (P = 0.103). Our results suggest that intracranial artery disease and prior cerebral infarction are not independent risk factors for stroke after OPCABG. Nonetheless, further investigation of these associations is necessary.

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Section: Discussionmentioning

confidence: 99%

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

et al. 2014

Neurophysiology

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“…Perioperative neurological injuries (stroke as well as cognitive dysfunction) seem to be the most devastating complications of CABG [1,10]. Stroke is classically characterized as a neurological deficit attributed to an acute focal cerebral, spinal or retinal injury of a vascular origin, including cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Predictors of intracranial cerebral artery stenosis in patients before cardiac surgery and its impact on perioperative and long-term stroke risk

Luchowski

Wojczal

Buraczynska

et al. 2015

Neurologia i Neurochirurgia Polska

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“…Postoperative CD is a well-documented neurological phenomenon that occurs after a variety of vascular and nonvascular procedures, including cardiac bypass surgery, 18,34 CEA, 14,23 carotid stenting, 9,35 carotid angioplasty, 32 diagnostic coronary angiography, 19 and noncardiac surgery. 26 The pathophysiology, incidence, and time course of CD vary depending on the specific surgery in question.…”

Section: Discussionmentioning

confidence: 99%

Complement polymorphisms and cognitive dysfunction after carotid endarterectomy

Heyer

Kellner

Malone

et al. 2013

JNS

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Object The role of genetic polymorphisms in the neurological outcome of patients after carotid endarterectomy (CEA) remains unclear. There are single nucleotide polymorphisms (SNPs) that predispose patients to postoperative cognitive dysfunction (CD). We aim to assess the predictability of three complement cascade-related SNPs for CD in patients having CEAs. Methods In 252 patients undergoing CEA, genotyping was performed for the following polymorphisms: complement component 5 (C5) rs17611, mannose-binding lectin 2 (MBL2) rs7096206, and complement factor H (CFH) rs1061170. Differences among genotypes were analyzed via the chi-square test. Patients were evaluated with a neuropsychometric battery for CD 1 day and 1 month after CEA. A multiple logistic regression model was created. All variables with univariate p < 0.20 were included in the final model. Results The C5 genotypes A/G (OR 0.26, 95% CI 0.11–0.60, p = 0.002) and G/G (OR 0.22, 95% CI 0.09–0.52, p < 0.001) were significantly associated with lower odds of exhibiting CD at 1 day after CEA compared with A/A. The CFH genotypes C/T (OR 3.37, 95% CI 1.69–6.92, p < 0.001) and C/C (OR 3.67, 95% CI 1.30–10.06, p = 0.012) were significantly associated with higher odds of exhibiting CD at 1 day after CEA compared with T/T. Statin use was also significantly associated with lower odds of exhibiting CD at 1 day after CEA (OR 0.43, 95% CI 0.22–0.84, p = 0.01). No SNPs were significantly associated with CD at 1 month after CEA. Conclusions The presence of a deleterious allele in the C5 and CFH SNPs may predispose patients to exhibit CD after CEA. This finding supports previous data demonstrating that the complement cascade system may play an important role in the development of CD. These findings warrant further investigation.

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Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting

Abstract: Patients with SBI were ranked at moderate risk of neurological complications after CABG between control and BI. Increased age, renal dysfunction, and preoperative cognitive impairment appeared to be strongly associated with SBI.

Cited by 32 publications

References 27 publications

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

Predictors of intracranial cerebral artery stenosis in patients before cardiac surgery and its impact on perioperative and long-term stroke risk

Complement polymorphisms and cognitive dysfunction after carotid endarterectomy

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