title: Predictors of intracranial cerebral artery stenosis in patients before cardiac surgery and its impact on perioperative and long-term stroke risk.
abstract: BACKGROUND
  The aim of this prospective study was to determine the prevalence of stenosis within intracranial and extracranial arteries in patients before coronary artery bypass surgery (CABG), to evaluate the influence of intracranial artery stenosis on neurological outcome and to identify preoperative risk factors for these patients.
  
  
  METHODS
  One hundred and seventy-five patients (71% males, mean age=66.1) scheduled for CABG were enrolled for extracranial Doppler duplex sonography, transcranial color-coded duplex sonography (TCCS) and transcranial Doppler (TCD) examination.
  
  
  RESULTS
  Twenty-six patients (14.7%) had extracranial stenosis or occlusion and 13 patients (7.3%) intracranial vascular disease. Six patients (3.5%) had both extra- and intracranial artery disease. The presence of peripheral artery disease and diabetes mellitus was a strong risk factor for extracranial artery stenosis but not for intracranial artery stenosis, which occurred independently also of typical atherosclerotic risk factors like age >70, male sex, hypertension, hyperlipidemia, hyperhomocysteinemia, smoking habit, obesity (BMI>30) and waist to hip ratio >1. Functional neurological outcome of the patients with intracranial arterial disease evaluated 7 days after CABG was the same as the patients without extra- and intracranial stenosis. However, 12-months neurological follow-up revealed significantly more ischemic strokes in patients with intracranial artery stenosis compared to patients without intracranial stenosis (p=0.015).
  
  
  CONCLUSIONS
  The occurrence of intracranial artery stenosis in CABG patients cannot be predicted by well-known atherosclerotic risk factors and seems not to be associated with perioperative stroke.
authors.affiliation: Department of Neurology, Medical University of Lublin, Lublin, Poland. Electronic address: pluchowski@wp.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Luchowski
authors.affiliation: Department of Neurology, Medical University of Lublin, Lublin, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Wojczal
authors.affiliation: Department of Neurology, Medical University of Lublin, Lublin, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Buraczynska
authors.affiliation: Department of Cardiosurgery, Medical University of Lublin, Lublin, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Kozlowicz
authors.affiliation: Department of Cardiosurgery, Medical University of Lublin, Lublin, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Stazka
authors.affiliation: Department of Neurology, Medical University of Lublin, Lublin, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Rejdak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D050197:Atherosclerosis / Q000453:epidemiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001026:Coronary Artery Bypass; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D017585:Ultrasonography, Doppler, Transcranial
keywords: Carotid artery stenosis; Coronary artery bypass surgery; Intracranial cerebral artery stenosis; Stroke; Transcranial Doppler ultrasonography