Abstract 11981: Can Preoperative Intensive Carotid And Intracranial Artery Screening Reduce Perioperative Strokes in Cardiovascular Surgery?
Introduction: The occurrence of stroke is a concern in patients undergoing cardiac surgery (CS) concomitant with carotid and/or intracranial artery disease (CIAD). Although the 2011 American Heart Association guidelines recommend screening only selected patients referred for elective CS, the clinical utility of CIAD screening is poorly understood.
Objectives: To evaluate the effectiveness of CIAD screening for patients undergoing elective CS.
Methods: Between February 2004 and December 2014, 1095 of 1134 patients (97%) underwent routine CIAD screening before CS at our institute. CS included coronary artery bypass grafting (CABG) in 378 (34%) patients, CABG + valve surgery in 151 (13%), valve surgery in 480 (42%), aortic surgery without brain protection in 43 (4%), and others in 82 (7%). Patients were divided as follows: those who underwent CS before (n=500) and those after (n=634) the introduction of intensive screening (IS) in January 2009. Preoperative screening had undergone transition in 2009, from the evaluation of carotid atherosclerosis alone to that of carotid and intracranial atherosclerosis. Moreover, patients detected with ≥moderate stenosis on IS underwent single-photon emission computed tomography (SPECT) with acetazolamide (ACZ). CIAD was classified based on the degree of stenosis as mild (0%-49% stenosis: n=836 [before/after: 370/466]), moderate (50%-69%: n=118 [56/62]), or severe (70%-100%: n=141 [36/105]).
Results: One of 166 (0.6%) patients with ≥moderate stenosis undergoing SPECT with ACZ was diagnosed with impaired cerebral autoregulation and underwent prophylactic superficial temporal artery to middle cerebral artery anastomosis 1 month before CABG. Subsequently, the patient underwent CABG without experiencing postoperative stroke. The introduction of IS significantly reduced the prevalence of perioperative stroke (2.8% vs. 0.9%, P=0.03) and permanent neurological dysfunction (2.4% vs. 0.5%, P=0.01). Additionally, prevalence of intraoperative stroke decreased significantly after the introduction of IS (1.4% vs. 0.2%, P=0.03).
Conclusions: Incidence of perioperative stroke decreased following the introduction of IS. Therefore, IS might help identify patients at risk of perioperative stroke.
Author Disclosures: K. Imasaka: None. E. Tayama: None. Y. Tomita: None.
- © 2016 by American Heart Association, Inc.