Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: Experience with intraoperative transesophageal echocardiography

Abstract

Protruding atheromas of the aortic arch identified by transesophageal echocardiography have been implicated as a cause of stroke in elderly patients. One hundred thirty patients greater than or equal to 65 years of age were studied with intraoperative transesophageal echocardiography to detect aortic arch protruding atheromas and determine if these patients were at higher risk for perioperative stroke. Protruding atheromas were identified in 23 (18%) of 130 patients. In 19 (83%) of these 23 patients, palpation of the aortic arch at operation did not identify significant abnormalities. Five patients (4%) had perioperative stroke. Logistic regression identified aortic arch atheroma as the only historical or procedural variable that was predictive of stroke (odds ratio 5.8, 95% confidence interval 1.2 to 27.9, p less than 0.03). A history of peripheral or cerebrovascular disease, presence of aortic calcification, cardiac risk factors, age and duration of cardiopulmonary bypass did not predict stroke. In contrast, patients with protruding atheromas with mobile components were at highest risk. There were 3 (25%) of 12 patients with a mobile atheroma who had a stroke versus 2 (2%) of 118 patients without a mobile atheroma (chi-square = 10.3, p = 0.001). Displacement and detachment of the frail, protruding atherosclerotic material by aortic arch cannulation or by the high pressure jet emanating from the cannula tip may play an important role in the creation of embolization and stroke.

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

“…21 Transesophageal echocardiography was performed in all patients to evaluate the severity of aortic atherosclerosis (using the Katz score). 22 Delirium assessment All patients were assessed for delirium six to 24 hr after extubation by a nurse trained to use the delirium rating scale R98 (DRS-R98). The DRS-R98 is composed of a 16-item clinician-rated scale.…”

Relation Between Mitral Annular Calcium and Complex Aortic Atheroma in Patients With Cerebral Ischemia Referred for Transesophageal Echocardiography

“…In earlier studies, however, the practice of the Echocardiography Laboratory was to report aortic atheroma severity according to a previous classification scheme. 15 In such instances, during extraction of data from echocardiogram reports, plaques that were reported to be Grades 1 or 2 (no plaque or intimal thickening) were given a "no atheroma" designation, while those reported as Grades 4 or 5 (≥5 mm in thickness or with mobile components) were classified as "complex atheroma". In the case of 36 patients, where Grade 3 (simple plaque <5 mm in thickness) was assigned in the reports, one echocardiographer (J.R.K.)…”

Seizure Induced by Insufflation of Bupropion

“…In an article published later that year, Katz et al used only a semiquantitative evaluation of the degree of atheroma. 6 Therefore, we conclude that the link to a study in which a genuinely quantitative method was used has disappeared without a trace.…”