Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting

We tried to determine whether postoperative CNS complications after off-pump coronary artery bypass grafting (OPCABG) are related to prior cerebral infarction or intracranial artery disease. Fifty-five patients (40 men, mean age 64.59 ± 8.86 years) subjected to OPCABG underwent neurological and n...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:Нейрофизиология
Datum:2014
Hauptverfasser: Bi, Q., J. -Yu Li, X. -Q. Li, Li, Q., Luo, D., Q. -B. Qiao
Format: Artikel
Sprache:English
Veröffentlicht: Інститут фізіології ім. О.О. Богомольця НАН України 2014
Online Zugang:https://nasplib.isofts.kiev.ua/handle/123456789/149051
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
Назва журналу:Digital Library of Periodicals of National Academy of Sciences of Ukraine
Zitieren:Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting / Q. Bi, J.-Yu Li, X.-Q. Li, Q. Li, D. Luo, Q.-B. Qiao // Нейрофизиология. — 2014. — Т. 46, № 6. — С. 566-572. — Бібліогр.: 29 назв. — англ.

Institution

Digital Library of Periodicals of National Academy of Sciences of Ukraine
id nasplib_isofts_kiev_ua-123456789-149051
record_format dspace
spelling Bi, Q.
J. -Yu Li
X. -Q. Li
Li, Q.
Luo, D.
Q. -B. Qiao
2019-02-19T13:20:46Z
2019-02-19T13:20:46Z
2014
Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting / Q. Bi, J.-Yu Li, X.-Q. Li, Q. Li, D. Luo, Q.-B. Qiao // Нейрофизиология. — 2014. — Т. 46, № 6. — С. 566-572. — Бібліогр.: 29 назв. — англ.
0028-2561
https://nasplib.isofts.kiev.ua/handle/123456789/149051
616.127–005.8+616.007.271
We tried to determine whether postoperative CNS complications after off-pump coronary artery bypass grafting (OPCABG) are related to prior cerebral infarction or intracranial artery disease. Fifty-five patients (40 men, mean age 64.59 ± 8.86 years) subjected to OPCABG underwent neurological and neuropsychological examinations 24 h before surgery. MRI was used to identify old and/or new ischemic lesions before surgery, and MRA was used to determine the presence and severity of intracranial artery disease. The patients were examined eight days after surgery; possible development of stroke or cognitive dysfunction was evaluated. Associations between postoperative stroke and potential predictors, including prior cerebral infarction and intracranial artery disease, were analyzed using univariate methods. Two of 55 (3.64%) patients had postoperative stroke, and no patient showed cognitive decline. Univariate analysis found no significant association between postoperative stroke and prior cerebral infarction detected by MRI (P = 0.378) or intracranial artery disease detected by MRA (P = 0.103). Our results suggest that intracranial artery disease and prior cerebral infarction are not independent risk factors for stroke after OPCABG. Nonetheless, further investigation of these associations is necessary.
Ми намагалися встановити, чи залежать післяопераційні ускладнення в ЦНС після шунтування коронарної артерії без застосування штучного кровообігу від наявності в попередній період церебрального геморагічного інсульту або стенозу краніальних артерій. 55 пацієнтів (40 чоловіків і 15 жінок, середній вік 64.59 ± 8.86 року), котрим була призначена вказана операція, були за добу перед нею піддані неврологічному та нейропсихологічному обстеженню. Магніторезонансне сканування (MRI) було використане для ідентифікації старих та/або нових ішемічних уражень, а магніторезонансна ангіографія (MRA) застосовувалася для встановлення наявності та ступеню стенозу краніальних артерій. Пацієнти були повторно обстежені через вісім діб після операції для виявлення можливих ускладнень (розвитку інсульту або когнітивної дисфункції). Зв’язки між розвитком постопераційного інсульту та можливими предикторами (попереднім інсультом та стенозом краніальних артерій) були проаналізовані із застосуванням методів варіаційної статистики. Післяопераційний інсульт розвився у двох із 55 пацієнтів (3.64 %); зниження рівня когнітивної активності не спостерігалося в жодному випадку. Аналіз не показав вірогідного зв’язку між розвитком післяопераційного інсульту та наявністю попереднього геморагічного інсульту (дані MRI; P = 0.378) або стенозу краніальних артерій (дані MRA; P= 0.103). Наші результати дозволяють вважати, що стеноз краніальних артерій та попередній інсульт не є незалежними факторами ризику щодо інсульту після шунтування коронарної артерії, але подальші дослідження можливості таких зв’язків є необхідними.
This study was supported by the Beijing Medicine Research and Development Fund (grant no.2009- 2075) and the Beijing Science and Technology Project (grant No. Z111107058811013).
en
Інститут фізіології ім. О.О. Богомольця НАН України
Нейрофизиология
Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
Вплив стенозу краніальних артерій та попереднього церебрального інсульту на ускладнення в цнс після шунтування коронарної артерії без застосування штучного кровообігу
Article
published earlier
institution Digital Library of Periodicals of National Academy of Sciences of Ukraine
collection DSpace DC
title Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
spellingShingle Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
Bi, Q.
J. -Yu Li
X. -Q. Li
Li, Q.
Luo, D.
Q. -B. Qiao
title_short Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
title_full Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
title_fullStr Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
title_full_unstemmed Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting
title_sort impact of intracranial artery disease and prior cerebral infarction on central nervous system complications after off-pump coronary artery bypass grafting
author Bi, Q.
J. -Yu Li
X. -Q. Li
Li, Q.
Luo, D.
Q. -B. Qiao
author_facet Bi, Q.
J. -Yu Li
X. -Q. Li
Li, Q.
Luo, D.
Q. -B. Qiao
publishDate 2014
language English
container_title Нейрофизиология
publisher Інститут фізіології ім. О.О. Богомольця НАН України
format Article
title_alt Вплив стенозу краніальних артерій та попереднього церебрального інсульту на ускладнення в цнс після шунтування коронарної артерії без застосування штучного кровообігу
description We tried to determine whether postoperative CNS complications after off-pump coronary artery bypass grafting (OPCABG) are related to prior cerebral infarction or intracranial artery disease. Fifty-five patients (40 men, mean age 64.59 ± 8.86 years) subjected to OPCABG underwent neurological and neuropsychological examinations 24 h before surgery. MRI was used to identify old and/or new ischemic lesions before surgery, and MRA was used to determine the presence and severity of intracranial artery disease. The patients were examined eight days after surgery; possible development of stroke or cognitive dysfunction was evaluated. Associations between postoperative stroke and potential predictors, including prior cerebral infarction and intracranial artery disease, were analyzed using univariate methods. Two of 55 (3.64%) patients had postoperative stroke, and no patient showed cognitive decline. Univariate analysis found no significant association between postoperative stroke and prior cerebral infarction detected by MRI (P = 0.378) or intracranial artery disease detected by MRA (P = 0.103). Our results suggest that intracranial artery disease and prior cerebral infarction are not independent risk factors for stroke after OPCABG. Nonetheless, further investigation of these associations is necessary. Ми намагалися встановити, чи залежать післяопераційні ускладнення в ЦНС після шунтування коронарної артерії без застосування штучного кровообігу від наявності в попередній період церебрального геморагічного інсульту або стенозу краніальних артерій. 55 пацієнтів (40 чоловіків і 15 жінок, середній вік 64.59 ± 8.86 року), котрим була призначена вказана операція, були за добу перед нею піддані неврологічному та нейропсихологічному обстеженню. Магніторезонансне сканування (MRI) було використане для ідентифікації старих та/або нових ішемічних уражень, а магніторезонансна ангіографія (MRA) застосовувалася для встановлення наявності та ступеню стенозу краніальних артерій. Пацієнти були повторно обстежені через вісім діб після операції для виявлення можливих ускладнень (розвитку інсульту або когнітивної дисфункції). Зв’язки між розвитком постопераційного інсульту та можливими предикторами (попереднім інсультом та стенозом краніальних артерій) були проаналізовані із застосуванням методів варіаційної статистики. Післяопераційний інсульт розвився у двох із 55 пацієнтів (3.64 %); зниження рівня когнітивної активності не спостерігалося в жодному випадку. Аналіз не показав вірогідного зв’язку між розвитком післяопераційного інсульту та наявністю попереднього геморагічного інсульту (дані MRI; P = 0.378) або стенозу краніальних артерій (дані MRA; P= 0.103). Наші результати дозволяють вважати, що стеноз краніальних артерій та попередній інсульт не є незалежними факторами ризику щодо інсульту після шунтування коронарної артерії, але подальші дослідження можливості таких зв’язків є необхідними.
issn 0028-2561
url https://nasplib.isofts.kiev.ua/handle/123456789/149051
citation_txt Impact of Intracranial Artery Disease and Prior Cerebral Infarction on Central Nervous System Complications After Off-Pump Coronary Artery Bypass Grafting / Q. Bi, J.-Yu Li, X.-Q. Li, Q. Li, D. Luo, Q.-B. Qiao // Нейрофизиология. — 2014. — Т. 46, № 6. — С. 566-572. — Бібліогр.: 29 назв. — англ.
work_keys_str_mv AT biq impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT jyuli impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT xqli impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT liq impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT luod impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT qbqiao impactofintracranialarterydiseaseandpriorcerebralinfarctiononcentralnervoussystemcomplicationsafteroffpumpcoronaryarterybypassgrafting
AT biq vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
AT jyuli vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
AT xqli vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
AT liq vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
AT luod vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
AT qbqiao vplivstenozukraníalʹniharteríitapoperednʹogocerebralʹnogoínsulʹtunauskladnennâvcnspíslâšuntuvannâkoronarnoíarterííbezzastosuvannâštučnogokrovoobígu
first_indexed 2025-11-25T23:46:46Z
last_indexed 2025-11-25T23:46:46Z
_version_ 1850584077447462912
fulltext NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6566 UDC 616.127–005.8+616.007.271 Q. BI,1 J.-Yu LI,2 X.-Q. LI,1 Q. LI,3 D. LUO,1 and Q.-B. QIAO4 IMPACT OF INTRACRANIAL ARTERY DISEASE AND PRIOR CEREBRAL INFARCTION ON CENTRAL NERVOUS SYSTEM COMPLICATIONS AFTER OFF-PUMP CORONARY ARTERY BYPASS GRAFTING Received 01.07.13 We tried to determine whether postoperative CNS complications after off-pump coronary artery bypass grafting (OPCABG) are related to prior cerebral infarction or intracranial artery disease. Fifty-five patients (40 men, mean age 64.59 ± 8.86 years) subjected to OPCABG underwent neurological and neuropsychological examinations 24 h before surgery. MRI was used to identify old and/or new ischemic lesions before surgery, and MRA was used to determine the presence and severity of intracranial artery disease. The patients were examined eight days after surgery; possible development of stroke or cognitive dysfunction was evaluated. Associations between postoperative stroke and potential predictors, including prior cerebral infarction and intracranial artery disease, were analyzed using univariate methods. Two of 55 (3.64%) patients had postoperative stroke, and no patient showed cognitive decline. Univariate analysis found no significant association between postoperative stroke and prior cerebral infarction detected by MRI (P = 0.378) or intracranial artery disease detected by MRA (P = 0.103). Our results suggest that intracranial artery disease and prior cerebral infarction are not independent risk factors for stroke after OPCABG. Nonetheless, further investigation of these associations is necessary. Keywords: off-pump coronary artery bypass grafting, prior cerebral infarction, intracranial artery disease, stroke. 1 Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 2 Emergency Department of Beijing Charity Hospital, China Rehabilitation Research Center, Capital Medical University School of Rehabilitation Medicine, Beijing, China. 3 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. 4 Department of Neurology, Xian Number Four Hospital, Xian, Shanxi Province, China. Correspondence should be addressed to Q. Bi (e-mail: biqidoctor@163.com). INTRODUCTION Devastating CNS complications, including stroke, can occur following coronary artery bypass grafting (CABG), with an incidence of 2.6-7.6% [1, 2]. Cognitive dysfunction (with an incidence of 30-65%) [3, 4], anxiety, and depression are also among such complications. These complications significantly increase disability and mortality of the patients, as well as healthcare costs [5, 6]. A number of risk factors can contribute to the occurrence of CNS complications after CABG, including age, unstable angina, prior stroke or transient ischemic attacks, carotid bruits, carotid artery disease, left ventricular ejection fraction (LVEF) below 50%, cardiopulmonary bypass, postoperative atrial fibrillation, and postoperative hypotension [6-9]. Intracranial artery disease is also an independent risk factor for CNS complications after CABG [10]. Postoperative CNS complications are thought to be due mainly to the adverse effect of cardiopulmonary bypass [11-13]. The incidence of stroke or cognitive dysfunctions does not decrease after off-pump coronary ar tery bypass graf t ing (OPCABG), although this method can avoid the adverse effects of extracorporal circulation [14]. Therefore, the risk factors for CNS complications after OPCABG must be re-examined. In our study, we prospectively studied patients undergoing OPCABG and tried to determine whether intracranial artery disease and prior cerebral infarction constitute potential risk factors for CNS complications. NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6 567 IMPACT OF INTRACRANIAL ARTERY DISEASE AND PRIOR CEREBRAL INFARCTION METHODS Examined Group. A total of 55 consecutive patients scheduled for OPCABG at the Beijing Anzhen Hospital were believed eligible for inclusion in the study. Patients with significant pre-existing neurological deficits (according to Mini-Mental State Examination, MMSE [15] scores) that would hamper interpretation of the clinical and radiological data, scores of the National Institute of Heart Stroke Scale below 4 [16], and/or contraindications for MRI (such as the use of a cardiac pacemaker) were not included in the group. Data Collection. The following potential risk factors for CNS complications after OPCABG were noted before surgery: history of stroke, hypertension, diabetes mellitus, hyperlipidemia, cardiac surgery, atrial fibrillation, smoking, and alcohol abuse. The MRI and MRA studies were performed before surgery. The MRI studies were repeated in patients with new symptoms of stroke after OPCABG to confirm the diagnosis of stroke. The results of MRI were examined by two imaging specialists to identify the presence of infarct foci. The intracranial arteries were examined to detect the presence of intracranial artery disease, defined as luminal narrowing exceeding 50% [17]. Among them, there were the intracranial internal carotid artery, anterior, middle, and posterior cerebral arteries, intracranial vertebral artery, and basilar artery. Assessment and Definition of CNS Complications. Neurological examinations of the patients’ cognitive functions, level of anxiety, and depression states were performed before and eight days after surgery to detect the presence of CNS complications. All assessments were performed by an investigator blinded to the MRI and MRA results. The MMSE, Clinical Dementia Rating (CDR), and Global Deterioration Scale (GDS) were used to evaluate the state of cognitive functions. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the anxiety level and depression state. The CNS complications were classified as stroke, mild cognitive impairment (MCI), depression, or abnormally high anxiety. Stroke was defined as a new focal neurological deficit lasting more than 24 h with an MRI finding consistent with a new ischemic injury. The diagnosis of MCI was made according to the following criteria: (i) memory complaint, (ii) normal activities in daily living, (iii) normal general cognitive function, (iv) memory abnormal for the patient’s age, and (v) absence of dementia [18]. Depression and anxiety were defined as SDS and SAS index values (transformed from raw scores) below or equal to 50, respectively [19]. MRI and MRA. All MRI studies were performed with a 1.5-Tesla scanner Sonata (Siemens Healthcare, Germany); T1-weighted images, T2-weighted images, and diffusion-weighted images (DWIs) were acquired using a spin echo sequence, a turbo spin echo sequence, and an echo planar imaging sequence, respectively. Three-dimensional time-of-flight MRA (Sonata, Siemens Healthcare, Germany) was used to assess the presence of intracranial artery disease. Perfusion- weighted imaging (PWI) results were processed with STROKETOOL software (Digital Image Solutions, Germany), supported by the Düsseldorf University Hospital. The regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), mean transit time (MTT), and time to peak (TTP) were values calculated and analyzed. Statistical Analysis. All data were analyzed using SPSS software (version 13.0; SPSS Inc., USA), with P ≤ 0.05 considered indications of significant intergroup differences. Continuous variables were expressed as means ± s.d., and categorical variables were expressed as numbers and frequencies. Univariate analysis was performed to determine differences in potential risk factors (including intracranial artery disease and prior stroke) between patients with and without CNS complications. Continuous variables were compared between groups using the t-test, and categorical variables were compared using the Fisher’s exact test. Multivariate logistic regression was not estimated because of a relatively small sampling. RESULTS Fifty-five participants (40 men), mean age 64.59 ± ± 8.86 (45-84) years, were enrolled in the study (Table 1). All patients completed neurological and neuropsychological assessments at baseline and postoperative neurological assessments at a mean of 5 ± ± 3 days after surgery. Two of the 55 patients (3.64%) suffered from a clinically evident postoperative stroke and new ischemic lesions on postoperative DWIs. One of these patients (patient 1 in Table 2) experienced the sudden onset of incomplete motor aphasia and hemianopia five days after surgery, and large areas of new ischemic lesions dispersed within the right occipital lobe were found on the postoperative DWI. Another NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6568 Q. BI, J.-Yu LI, X.-Q. LI et al. patient (patient 2 in Table 2) experienced aphasia and paralysis + numbness of the left upper limb, with new lesions on the right temporal lobe and right basal ganglia detected on the postoperative DWI. These two patients were more than 60 years old and had histories of hyperlipidemia and diabetes mellitus, but these factors showed no significant difference from the rest of the patient sampling. Other variables, including risk factors for preoperative stroke, cardiac surgery history, and LVEF below 40%, did not differ between patients with and without postoperative stroke (Table 3). Preoperative MRI revealed subclinical (old) infarcts in the above two patients with postoperative stroke, but this finding did not differ significantly from those for their counterparts without postoperative stroke (P = 0.378). The MRA findings for intracranial artery disease also showed no difference between patients with and without postoperative stroke (P = 0.103; T a b l e 1. Baseline characteristics and outcomes of 55 patients undergoing off-pump coronary artery bypass grafting Т а б л и ц я 1. Основні характеристики 55 пацієнтів, яким проводили шунтування коронарної артерії без використання штучного кровообігу Item Total (n = 55) Stroke (n = 2) No stroke (n = 53) P Mean age, years 64.85 ± 8.72 63.00 ± 0.00 64.92 ± 8.88 0.762 Stroke history 10 0 10 0.667 History of high lipids 31 2 29 0.313 Cardiac surgery history 4 0 4 0.859 Atrial fibrillation 4 0 4 0.859 History of hypertension 36 1 35 0.576 Diabetes mellitus 15 2 13 0.071 Smoking 27 1 26 0.745 Alcohol consumption 16 1 15 0.525 Carotid artery stenosis 13 1 12 0.449 Left ventricular ejection fraction < 40% 2 1 1 0.072 Hypertension* 7 1 6 0.246 High glucose* 13 2 11 0.055 High lipids* 23 0 23 0.504 Infarction before surgery (MRI) 34 2 32 0.378 Intracranial artery disease before surgery (MRA) 18 2 16 0.103 Footnotes: MRI is magnetic resonance imaging; MRA is magnetic resonance angiography. Asterisks shows preoperative assessment. T a b l e 2. Clinical and radiological characteristics of the patients with postoperative stroke Т а б л и ц я 2. Клінічні та радіологічні характеристики пацієнтів із постопераційним інсультом Patient Age (years) Sex Risk factors Preop. MRI findings Preop. MRA findings Postop. MRI findings Clinical manifestations 1 63 Male HL, CAD, DM, smoking, unilateral carotid disease Prior cerebral infarction Mild stenosis of the left middle cerebral artery Right occipital lobe DWI (+) Motor aphasia, hemianopia 2 63 Male HL,CAD, DM, HTN, LVEF <40% Prior cerebral infarction Mild stenosis of the bilateral posterior cerebral arteries Right temporal lobe, right basal ganglia DWI(+), Paralysis and numbness of the left upper limb, aphasia Footnotes: Preop., preoperative; Postop., postoperative; MRI, magnetic resonance imaging; MRA, magnetic resonance angiography; HL, high lipids; CAD, coronary artery disease; DM, diabetes mellitus; HTN, hypertension; LVEF, left ventricular ejection fraction; DWI, diffusion-weighted image. NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6 569 IMPACT OF INTRACRANIAL ARTERY DISEASE AND PRIOR CEREBRAL INFARCTION Table 3). Patient 1 had mild stenosis of the left middle cerebral artery that was not related to new infarction. Patient 2 had mild stenosis of the bilateral posterior cerebral arteries that was responsible for new ischemic lesions (Table 2). No significant difference was found in pre- and postoperative rCBF, rCBV, MTT, or TTP values on functional MRI for all 55 patients (P > 0.05; Table 3). N o p a t i e n t s h o w e d a d e c l i n e i n t h e neuropsychological measures (Table 4); changes in MMSE (P = 0.352) and CDR (P = 0.322) scores were insignificant. Pre- and postoperative GDS scores did not differ from each other, and estimates of the psychomotor speed, mental flexibility, and memory tests were generally similar. Seven participants had mildly increased anxiety, and one patient suffered from mild depression, as determined by the preoperative administration of the SAS and SDS. Anxiety levels declined in two patients after surgery, but these changes in the anxiety level and depression were, in general, insignificant. DISCUSSION Cerebral injury is a devastating complication of CABG; globally, stroke occurs in 1.5-7.6% of the patients, encephalopathy affects 8.4-32% of those, and cognitive dysfunction affects 20-65% of the patients at discharge [1-4, 20]. Variation in the incidences reported by different studies is likely due to differences in the patient samplings (e.g., patient age and risk status, types of procedures), diagnostic definitions, and intensity of clinical surveillance. The results of our study confirmed that neurological injury is relatively common after cardiac surgery, with approximately 4% of the patients experiencing postoperative stroke. In previous studies [6, 8, 9, 21], the causative mechanisms and risk factors for perioperative strokes in patients undergoing CABG were determined. The incidence of postoperative stroke correlates mainly with the adverse effect of cardiopulmonary bypass due to large numbers of microemboli built by fragments of atheromatous plaques from the ascending T a b l e 3. Pre- and postoperative perfusion-weighted imaging findings Т а б л и ц я 3. Пре- та постопераційні усереднені значення характеристик перфузії мозку Parameter Preoperative Postoperative t P rCBF(ml/100g/min): left hemisphere 9.198 ± 5.498 9.045 ± 3.979 0.202 0.841 right hemisphere 9.134 ± 5.527 9.173 ± 4.247 –0.042 0.967 rCBV(ml/100g): left hemisphere 46.211 ± 14.397 44.641 ± 16.036 0.548 0.586 right hemisphere 46.261 ± 16.966 45.852 ± 16.419 0.170 0.866 MTT(s): left hemisphere 35.234 ± 9.480 35.907 ± 11.015 –0.286 0.777 right hemisphere 35.786 ± 10.543 35.686 ± 10.421 0.042 0.967 TTP(s): left hemisphere 37.839 ± 4.952 37.361 ± 3.307 0.713 0.480 right hemisphere 38.064 ± 5.033 37.157 ± 2.952 1.312 0.196 Footnotes: rCBF, regional cerebral blood flow; rCBV, regional cerebral blood volume; MTT, mean transit time; TTP, time to peak. T a b l e 4. Neuropsychological characteristics of the patients before and after cardiac surgery Т а б л и ц я 4. Нейропсихологічні характеристики пацієнтів перед операцією на серці та після неї Preoperative Postoperative t P Mini-Mental State Examination 28.45 ± 1.89 28.34 ± 2.53 0.515 0.352 Clinical Dementia Rating 0.16 ± 0.27 0.17 ± 0.28 –1.000 0.322 Global Deterioration Scale 1.23 ± 0.42 1.23 ± 0.42 NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6570 Q. BI, J.-Yu LI, X.-Q. LI et al. aorta, thrombi, platelets, destroyed red blood cells, white blood cells, lipids, and gas [11, 13, 22]. Although OPCABG can avoid the adverse effects of extracorporeal circulation, a noticeable proportion of the patients still suffer from postoperative stroke [14]. In many studies, the relationship between carotid artery disease and risk of stroke after OPCABG was evaluated, although this correlation remains controversial [2, 23]. A few studies have examined the effect of intracranial artery disease on stroke after CABG. Yoon et al. [10] found that intracranial artery disease was associated independently with the development of CNS complications after CABG (prevalence odds ratio, 2.28, with a 1.04-5.01confidence interval, after controlling for covariates, including age, occurrence of intraoperative events, and reoperation). Cheng-Ching et al. [24] also found that intracranial atherosclerosis may be an under-reported mechanism of perioperative stroke after open-heart surgery. However, only few studies have systematically investigated the role of intracranial artery disease as a risk factor for postoperative stroke in patients undergoing OPCABG. It was found that a history of stroke is an independent risk factor for postoperative stroke after CABG [25]. At the same time, single studies have investigated the relationship between prior ischemic lesions, including subclinical cerebral infarction, and postoperative stroke following OPCABG. In our study, the two patients who suffered from postoperative stroke had intracranial artery disease and ischemic lesions on preoperative MRI. Although prior cerebral infarction and intracranial artery disease appeared to be more prevalent in patients who experienced postoperative stroke than in those who did not, this difference was not found to be significant in our study, probably due in part to a small sampling size. Further studies are required to better understand the predictive values of intracranial artery disease and prior cerebral infarction for postoperative stroke. Atherosclerosis is a systemic process, and risk factors for coronary artery disease can also affect the intracranial arteries. Coronary artery disease is prevalent in patients with stroke, including subclinical forms of the latter. Yoon et al. [10] found that 16.4% of the patients undergoing non-emergency isolated CABG had intracranial artery disease alone, and 13.9% had extra- and intracranial artery disease. Ito et al. [26] found that almost half (49.9%) of the patients who underwent CABG had silent (35.2%) or symptomatic (14.7%) brain infarction. In our study, brain MRI with DWI and MRA findings revealed that 61.8% of the patients who underwent OPCABG had prior cerebral infarction, and 32.7% had intracranial artery disease. Considering the high incidence of prior cerebral infarction and intracranial artery disease in patients undergoing OPCABG, these patients should be identified for these conditions before surgery. The cognitive decline was reported to occur in 30- 70% of the patients in the first week after cardiac surgery; this incidence declines to 30-50% at three weeks after surgery and may persist for one year [27, 28]. However, the incidence of postoperative cognitive impairment remains controversial and varies greatly depending on the patient’s characteristics, the tests used to evaluate cognitive function, definitions of cognitive impairment, and the duration of follow up. No patient in our study showed severe cognitive impairment. Several explanations account for the discrepancies among the described results. Our study included only patients undergoing OPCABG, which is less likely than on- pump CABG to result in CNS complications. The small sample size may also influence the results. A reliable and semiquantitative method for estimating cerebral hemodynamics is PWI. The ability of PWI to assess CBF and metabolism is comparable to that of positron emission tomography. In our study, no significant difference in pre- and postoperative values of these parameters was observed. These results likely reflect the ability of OPCABG to improve neurological outcomes by avoiding hemodynamic, inflammatory, and microembolic perturbations associated with cardiopulmonary bypass [29]. Our study had several l imitations. As was mentioned, the sampling examined was relatively small, and the timing of postoperative assessment (8 days after surgery) was pragmatic, based on the timing of patient discharge. Cognitive assessments performed at a greater interval after surgery may be more clinically relevant. Our findings can be summarized in the following way. About 4% of the patients examined who underwent OPCABG had a perioperative stroke, but no patient showed cognitive decline. These findings are consistent with the absence of changes detected by PWI. Intracranial artery disease and prior cerebral infarction may not be independent risk factors for stroke after OPCABG. However, further studies are required to better understand the predictive values of these conditions for postoperative stroke. NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6 571 IMPACT OF INTRACRANIAL ARTERY DISEASE AND PRIOR CEREBRAL INFARCTION Acknowledgements This study was supported by the Beijing Medicine Research and Development Fund (grant no.2009- 2075) and the Beijing Science and Technology Project (grant No. Z111107058811013). The institutional review board approval and a waiver of individual consent requirements were obtained for this study. The authors, Q. Bi, J.-Yu Li, X.-Q. Li, Q. Li, D. Luo, and Q.-B. Qiao, declare that they have no competing interests. К. Бі1, Дж.-Ю Лі2, Кс.-К. Лі1, К. Лі1, Д. Луо1, К.-В. Кьяо2 ВПЛИВ СТЕНОЗУ КРАНІАЛЬНИХ АРТЕРІЙ ТА ПОПЕРЕДНЬОГО ЦЕРЕБРАЛЬНОГО ІНСУЛЬТУ НА УСКЛАДНЕННЯ В ЦНС ПІСЛЯ ШУНТУВАННЯ КОРОНАРНОЇ АРТЕРІЇ БЕЗ ЗАСТОСУВАННЯ ШТУЧНОГО КРОВООБІГУ 1 Столичний медичний університет, Пекін (Китай). 2 Пекінський інститут хвороб серця, легень та кровонос- них судин, Пекін (Китай). Р е з ю м е Ми намагалися встановити, чи залежать післяопераційні ускладнення в ЦНС після шунтування коронарної артерії без застосування штучного кровообігу від наявності в попередній період церебрального геморагічного інсульту або стенозу краніальних артерій. 55 пацієнтів (40 чоловіків і 15 жінок, середній вік 64.59 ± 8.86 року), котрим була при- значена вказана операція, були за добу перед нею піддані неврологічному та нейропсихологічному обстеженню. Магніторезонансне сканування (MRI) було використане для ідентифікації старих та/або нових ішемічних уражень, а магніторезонансна ангіографія (MRA) застосовувалася для встановлення наявності та ступеню стенозу краніальних артерій. Пацієнти були повторно обстежені через вісім діб після операції для виявлення можливих ускладнень (розвит- ку інсульту або когнітивної дисфункції). Зв’язки між розвит- ком постопераційного інсульту та можливими предиктора- ми (попереднім інсультом та стенозом краніальних артерій) були проаналізовані із застосуванням методів варіаційної статистики. Післяопераційний інсульт розвився у двох із 55 пацієнтів (3.64 %); зниження рівня когнітивної активності не спостерігалося в жодному випадку. Аналіз не пока- зав вірогідного зв’язку між розвитком післяопераційного інсульту та наявністю попереднього геморагічного інсульту (дані MRI; P = 0.378) або стенозу краніальних артерій (дані MRA; P= 0.103). Наші результати дозволяють вважати, що стеноз краніальних артерій та попередній інсульт не є не- залежними факторами ризику щодо інсульту після шун- тування коронарної артерії, але подальші дослідження можливості таких зв’язків є необхідними. REFERENCES 1. C. Mérie, L. Køber, P. S. Olsen, et al., “Risk of stroke after coronary artery bypass grafting: effect of age and comorbidities,” Stroke, 43, 38-43 (2012). 2. S. Miyazaki, K. Yoshitani, and N. Miura, “Risk factors of stroke and delirium after off-pump coronary artery bypass surgery. Interact,” Cardiovascul. Thorac. Surg., 12, 379-383 (2011). 3. M. F. Newman, J. L. Kirchner, B. Phillips-Bute, et al., “Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery,” New Engl. J. Med., 344, 395- 402 (2001). 4. A. E. V. Harten, T. W. L. Scheeren, and A. R. Absalom, “A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia,” Anaesthesia, 66, 280-293 (2012). 5. L. J. Dacey, D. S. Likosky, B. J. Leavitt, et al., “Perioperative stroke and long-term survival after coronary artery bypass graft,” Ann. Thorac. Surg., 79, 532-536 (2005). 6. J. D. Puskas, A. D. Winston, C. E. Wright, et al., “Stroke after coronary artery operation, incidence, correlates, outcome, and cost,” Ann. Thorac. Surg., 69, 1053-1056 (2000). 7. L. Cao, Q. Li, Q. Bi, and Q. J. Yu, “Risk factors for recurrent stroke after coronary artery bypass grafting,” J. Cardiothorac. Surg., 6, 157-161 (2011). 8. A. C. Anyanwu, F. Filsoufi, S. P. Salzberg, et al. , “Epidemiology of stroke after cardiac surgery in the current era,” J. Thorac. Cardiovascul. Surg., 134, 1121-1127 (2007). 9. M. Abbaszadeh, “The impact of carotid artery disease on outcomes of patients undergoing coronary artery bypass grafting,” Rev. Bras. Circ. Cardiovascul., 26, 258-263 (2011). 10. B. W. Yoon, H. J. Bae, D. W. Kang, et al., “Intracranial cerebral artery disease as a risk factor for central nervous system complications of coronary artery bypass graft surgery,” Stroke, 32, 94-99(2001). 11. D. C. Likosky, B. J. Leavitt, C. A. S. Marrin, et al., “Intra- and postoperative predictors of stroke after coronary artery bypass grafting,” Ann. Thorac. Surg., 76, 428-434 (2003). 12. S. C. Stamou, P. C. Hill, G. Dangas, et al., “Stroke after coronary artery bypass: incidence, predictors, and clinical outcome,” Stroke, 32, 1508-1513 (2001). 13. D. Russell and N. Bornstein, “Methods of detecting potential causes of vascular cognitive impairment after coronary artery bypass grafting,” J. Neurol. Sci., 229/230, 69-73 (2005). 14. K. Nishiyama, M. Horiguchi, S. Shizuta, et al., “Temporal pattern of strokes after on-pump and off-pump coronary artery bypass graft surgery,” Ann. Thorac. Surg., 87, 1839- 1845 (2009). 15. M. F. Folstein, S. E. Folstein, and P. R. McHugh, “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician,” J. Psychiat. Res., 12, 189-198 (1975). 16. J. Ferrari, M. Knoflach, S. Kiechl, et al., “Austrian stroke unit registry collaborators. Early clinical worsening in patients with TIA or minor stroke: the Austrian stroke unit registry,” Neurology, 74, 136-141 (2010). 17. T. Uehara, M. Tabuchi, T. Hayashi, et al., “Asymptomatic occlusive lesions of carotid and intracranial arteries in NEUROPHYSIOLOGY / НЕЙРОФИЗИОЛОГИЯ.—2014.—T. 46, № 6572 Q. BI, J.-Yu LI, X.-Q. LI et al. Japanese patients with ischemic heart disease,” Stroke, 27, 393-397 (1996). 18. R. C. Petersen, G. E. Smith, S. C. Waring, et al., “Mild cognitive impairment. Clinical characterization and outcome,” Arch. Neurol., 56, 303-308 (1999). 19. K. J. Nan, Y. C. Wei, F. L. Zhou, et al., “Effects of depression on parameters of cell-mediated immunity in patients with digestive tract cancers,” World J. Gastroenterol., 10, 268-272 (2004). 20. G. M. McKhann, M. A. Grega, L. M. Borowicz, Jr., et al., “Stroke and encephalopathy after cardiac surgery: an update,” Stroke, 37, 562-571 (2006). 21. C. W. Hogue, R. F. Gottesman, and J. Stearns, “Mechanisms of cerebral injury from cardiac surgery,” Crit. Care Clin., 24, 83- 98 (2008). 22. S. C. Stamou, P. C. Hill, G. Dangas, et al., “Stroke after coronary artery bypass: incidence, predictors, and clinical outcome,” Stroke, 32, 1508-1513 (2001). 23. S. Manabe, T. Shimokawa, T. Fukui, et al., “Influence of carotid artery stenosis on stroke in patients undergoing off- pump coronary artery bypass grafting,” Eur. J. Cardiothorac. Surg., 34, 1005-1008 (2008). 24. E. Cheng-Ching, J. Fong, D. Ontaneda, et al., “Intracranial atherosclerosis as a risk factor for ischemic stroke during open heart surgery,” J. Stroke Cerebrovascul. Dis., 19, 257-260 (2010). 25. Y. G. Wan, D. Xu, H. J. Wang, et al., “Impact of prior cerebral infarction on in-hospital mortality in patients with acute myocardial infarction,” Zhonghua Nei Ke Za Zhi., 50, 747-749 (2011). 26. A. Ito, T. Goto, K. Maekawa, et al. , “Postoperative neurological complications and risk factors for pre-existing silent brain infarction in elderly patients undergoing coronary artery bypass grafting,” J. Anesth., 26, 405-411 (2012). 27. G. L. Bryson and A. Wyand, “Evidence based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction,” Can. J. Anaesth., 53, 669-667 (2006). 28. K. K. Martin, J. B. Wigginton, V. L. Babikian, et al., “Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review,” Am. J. Surg., 197, 55-63 (2009). 29. D. C. Cheng, D. Bainbridge, J. E. Martin, and R. J. Novick, “Evidence-based perioperative clinical outcomes research group: Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials,” Anesthesiology, 102, 188-203 (2005).

Ähnliche Einträge