Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: relation to neurocognitive function☆

Knipp, Stephan; Matatko, Nadine; Schlamann, Marc; Wilhelm, Hans; Thielmann, Matthias; Forsting, Michael; Diener, H.‐C.; Jakob, Heinz

doi:10.1016/j.ejcts.2005.02.043

Cited by 126 publications

(97 citation statements)

References 24 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The incidence of new ischemic lesions detected by brain MRI in our study was 7.9%. This contrasts with on-bypass cardiac surgery studies in which a high number of postoperative lesions were detected by MRI: 47% after valvular surgery 26 and 30% after on-pump CABG. 27 In a prior study of OPCAB, although the patient number was small (n = 13), no postoperative embolic ischemic events were observed.…”

Section: Consent Withdrawn N=1 (New Onset Claustrophobia In Mri)contrasting

confidence: 41%

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

View full text Add to dashboard Cite

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...

show abstract

Section: Consent Withdrawn N=1 (New Onset Claustrophobia In Mri)contrasting

confidence: 41%

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

View full text Add to dashboard Cite

show abstract

“…[11][12][13] Whatever the mechanism, these lesions will be seen on diffusion-weighted imaging (DWI), if at least some of them occur due to an acute process. Given that DWI has a unique contrast property and a relatively short acquisition time, this imaging technique has been incorporated into many routine brain MR protocols, including, among others, protocols for strokes, [18][19][20][21] headaches, seizures, and tumors. [22][23][24] Over the past few years, we have used DWI for our routine brain protocol assuming that incidental infarcts would be identified on DWI performed in a general patient population.…”

mentioning

confidence: 99%

Incidental Acute Infarcts Identified on Diffusion-Weighted Images: A University Hospital-Based Study: Fig 1.

Yamada¹,

Nagakane²,

Sasajima³

et al. 2008

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…[9][10][11][12][13][14][15][16][17][18][19][20] DW-MRI is sufficiently sensitive for detection of small ischemic lesions in the brain after CABG or valve surgery. [24][25][26] Conversely, relatively few TIAs or strokes are expected after these types of cardiac surgery (%3%) [1][2][3] , similar to the levels seen in patients undergoing carotid endarterectomy or stenting. 31,32 Thus, DW-MRI is being used increasingly as a surrogate marker for stroke.…”

Section: Discussionmentioning

confidence: 86%

“…In accordance with previous studies, [24][25][26] new ischemic brain lesions were defined as ''hyperintense regions'' on postintervention DWIs that were not present on pretreatment images. The location, number, and volume of hyperintense lesions on DWI were evaluated by a radiologist and neurologist blinded to the treatment allocation, with disagreements resolved by consensus.…”

Section: Mrimentioning

confidence: 99%

“…31,32 Thus, DW-MRI is being used increasingly as a surrogate marker for stroke. [24][25][26] In addition to imaging manifestations of brain ischemia, cognitive changes represent important signs of ischemic lesions in the brain after cardiac surgery. Studies have suggested that perioperative brain injury caused by embolization of the neurovasculature during cardiac surgery is associated with temporary postoperative cognitive dysfunction and may trigger chronic or progressive dementia.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sonolysis in prevention of brain infarction during cardiac surgery (Sonorescue): a randomized, controlled trial

Školoudík

Hurtikova

Brát

et al. 2015

Journal of the Neurological Sciences

View full text Add to dashboard Cite

Here, we examined whether intraoperative sonolysis can alter the risk of new ischemic lesions in the insonated brain artery territory during coronary artery bypass grafting (CABG) or valve surgery. Silent brain ischemic lesions could be detected in as many as twothirds of patients after CABG or valve surgery.Patients indicated for CABG or valve surgery were allocated randomly to sonolysis (60 patients, 37 males; mean age, 65.3 years) of the right middle cerebral artery (MCA) during cardiac surgery and control group (60 patients, 37 males; mean age, 65.3 years). Neurologic examination, cognitive function tests, and brain magnetic resonance imaging (MRI) were conducted before intervention as well as 24 to 72 hours and 30 days after surgery.New ischemic lesions on control diffusion-weighted MRI in the insonated MCA territory !0.5 mL were significantly less frequent in the sonolysis group than in the control group (13.3% vs 26.7%, P ¼ 0.109). The sonolysis group exhibited significantly reduced median volume of new brain ischemic lesions (P ¼ 0.026). Stenosis of the internal carotid artery !50% and smoking were independent predictors of new brain This study provides class-II evidence that sonolysis during CABG or valve surgery reduces the risk of larger, new ischemic lesions in the brain.www.clinicaltrials.gov (NCT01591018).

show abstract

Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: relation to neurocognitive function☆

Cited by 126 publications

References 24 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

Incidental Acute Infarcts Identified on Diffusion-Weighted Images: A University Hospital-Based Study: Fig 1.

Sonolysis in prevention of brain infarction during cardiac surgery (Sonorescue): a randomized, controlled trial

Contact Info

Product

Resources

About