[The role of multislice tomography to prevent postoperative strokes related with atherosclerotic plaques in the ascending aorta after coronary artery bypass].
OBJECTIVE
Atheromatous plaques in the ascending aorta are major risk factors for strokes caused by macroembolization after coronary artery surgery. Detection of plaque formations and changes in the surgical strategy are very important. This study was planned to compare value direct palpation and multislice computerized tomography to establish aortic plaques and to establish clinical predictors of aortic calcification.


METHODS
Fifty-four patients who underwent coronary bypass surgery were included in this prospective and diagnostic study. Proximal portion of each patient's aorta was evaluated with multislice computerized tomography and was compared with direct palpation. The efficacy of intraoperative palpation to predict calcifications was studied with ROC analysis and the predictors of aortic plaque formation were analyzed using logistic regression analysis.


RESULTS
Atheromatous plaques were detected with palpation in four patients (7.4%), and with multislice tomography in six patients (11.1%). The aortic instrumentation was changed in two patients (3.7%) and strategy was changed in one patient 1.8%). According to the ROC analysis, when multislice computerized tomography was taken as the reference, intraoperative direct palpation was 67% sensitive and 100% specific to predict aortic plaques. Logistic regression analysis of the risk factors showed that the older age was the only significant risk factor (OR-1.3, 95% CI -1.114-1.568, p=0.001) for plaque formation in the aorta. Neither stroke nor other neurological disorders have been observed during the study.


CONCLUSIONS
It can be stated that multislice computerized tomography is more effective to show aortic plaques, but it is not sufficient. Multislice tomography may give additional information about the ascending aorta and the opportunity to visualize the aortic arch. It can be preferred in patients with aortic aneurysm or dissection.
Hastaoğlu
I Oral
IO
Dr. Siyami Ersek Göğüs, Kalp ve Damar Cerrahisi Eğitim ve Araştirma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Istanbul, Türkiye.
Sokullu
Onur
O
Sanioğlu
Soner
S
Sahin
Sinan
S
Kut
M Sinan
MS
Deniz
Hayati
H
Ayoğlu
Umut
U
Toköz
Hamdi
H
Bilgen
Fuat
F
D001011:Aorta / Q000473:pathology* / Q000601:surgery; D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards