White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting.
BACKGROUND
The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting.


METHODS
The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications.


RESULTS
More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications.


CONCLUSIONS
Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.
Andréll
Paulin
P
Multidisciplinary Pain Center, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. paulin.andrell@paincenter.se
Jensen
Christer
C
Norrsell
Henrik
H
Ekre
Olof
O
Ekholm
Sven
S
Norrsell
Ulf
U
Eliasson
Tore
T
Mannheimer
Clas
C
Blomstrand
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery / Q000628:therapy; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D001026:Coronary Artery Bypass; D004599:Electric Stimulation Therapy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D013116:Spinal Cord; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014463:Ultrasonography