Thickened intima of the aortic arch is a risk factor for stroke with coronary artery bypass grafting.
BACKGROUND
Perioperative stroke is one of the most serious complications of cardiac surgery.


METHODS
Using transesophageal echocardiography, we estimated the intimal thickness of the thoracic aorta as an index of the severity of aortic atherosclerosis to determine the risk of stroke in coronary artery bypass grafting (CABG) patients. The study population comprised 315 consecutive patients who underwent isolated CABG with cardiopulmonary bypass.


RESULTS
Five patients (1.6%) had perioperative cerebral stroke or systemic emboli. We compared the mean intimal thicknesses of the ascending aorta, aortic arch, and descending aorta. Mean thicknesses in patients without stroke were 2.07 +/- 0.76, 2.78 +/- 1.15, and 2.32 +/- 1.21 mm, respectively, and mean thicknesses in the stroke patients were 1.94 +/- 0.55, 6.94 +/- 3.79, and 3.39 +/- 1.85 mm, respectively. The patients with an intima of more than 5 mm at the aortic arch had a significantly greater incidence of perioperative stroke (p = 0.007).


CONCLUSIONS
These results suggest that patients who have an aortic arch intima thickened to more than 5 mm are at a significantly high risk for perioperative stroke, and thus, the CABG procedure should be carefully evaluated to prevent such complications.
Mizuno
T
T
Department of Cardiovascular Surgery, Kameda Medical Center, Kamogawa City, Chiba, Japan.
Toyama
M
M
Tabuchi
N
N
Kuriu
K
K
Ozaki
S
S
Kawase
I
I
Horimi
H
H
D000368:Aged; D001011:Aorta / Q000473:pathology; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D001018:Aortic Diseases / Q000473:pathology; D001161:Arteriosclerosis / Q000473:pathology; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology