New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors
Objective New brain infarcts after coronary artery bypass graft (CABG) are markedly more frequent than clinically evident stroke and have been proposed as a surrogate marker of postprocedural stroke. We sought to investigate the lesion patterns, mechanisms, and predictors of new brain infarction aft...
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| Veröffentlicht in: | Annals of neurology 2014-09, Vol.76 (3), p.347-355 |
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| container_title | Annals of neurology |
| container_volume | 76 |
| creator | Nah, Hyun-Wook Lee, Jae-Won Chung, Cheol-Hyun Choo, Suk-Jung Kwon, Sun U. Kim, Jong S. Warach, Steven Kang, Dong-Wha |
| description | Objective
New brain infarcts after coronary artery bypass graft (CABG) are markedly more frequent than clinically evident stroke and have been proposed as a surrogate marker of postprocedural stroke. We sought to investigate the lesion patterns, mechanisms, and predictors of new brain infarction after CABG surgery.
Methods
This was a prospective pre‐ and postoperative brain magnetic resonance imaging (MRI) study in consecutive patients who underwent isolated CABG. Preoperative MRI included diffusion‐weighted imaging (DWI) and magnetic resonance angiography. DWI was repeated on postoperative day 3. Clinical variables, intraoperative findings, and laboratory findings were compared between patients with and without new brain infarcts on DWI.
Results
Of a total of 127 included patients, 35 (27.6%) showed new brain infarcts on DWI. Most lesions were clinically silent, located in the cortical territory (80%), small ( |
| doi_str_mv | 10.1002/ana.24238 |
| format | Article |
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New brain infarcts after coronary artery bypass graft (CABG) are markedly more frequent than clinically evident stroke and have been proposed as a surrogate marker of postprocedural stroke. We sought to investigate the lesion patterns, mechanisms, and predictors of new brain infarction after CABG surgery.
Methods
This was a prospective pre‐ and postoperative brain magnetic resonance imaging (MRI) study in consecutive patients who underwent isolated CABG. Preoperative MRI included diffusion‐weighted imaging (DWI) and magnetic resonance angiography. DWI was repeated on postoperative day 3. Clinical variables, intraoperative findings, and laboratory findings were compared between patients with and without new brain infarcts on DWI.
Results
Of a total of 127 included patients, 35 (27.6%) showed new brain infarcts on DWI. Most lesions were clinically silent, located in the cortical territory (80%), small (<1.5cm) in diameter (89%), and not related to the underlying cerebral arterial abnormality (80%). Old age (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.03–1.15), use of cardiopulmonary bypass (OR = 3.12, 95% CI = 1.13–8.57), a moderate to severe aortic plaque (OR = 21.17, 95% CI = 2.01–222.58), and high levels of high‐sensitivity C‐reactive protein (OR = 1.35, 95% CI = 1.08–1.70) were independent predictors of new brain infarction.
Interpretation
Post‐CABG new brain infarcts are mostly silent and cortically located. Old age, aortic arch atherosclerosis, use of cardiopulmonary bypass, and systemic inflammatory response may contribute to the pathogenesis of post‐CABG new brain infarcts. Ann Neurol 2014;76:347–355</description><identifier>ISSN: 0364-5134</identifier><identifier>EISSN: 1531-8249</identifier><identifier>DOI: 10.1002/ana.24238</identifier><identifier>PMID: 25111072</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adult ; Age Factors ; Aged ; Aortic Diseases - complications ; Aortic Diseases - pathology ; Atherosclerosis - complications ; Atherosclerosis - pathology ; Brain Infarction - blood ; Brain Infarction - etiology ; Brain Infarction - pathology ; C-Reactive Protein - analysis ; Cardiology ; Cardiopulmonary Bypass - adverse effects ; Cerebral Cortex - blood supply ; Cerebral Cortex - pathology ; Confidence intervals ; Coronary Artery Bypass - adverse effects ; Coronary Artery Disease - surgery ; Coronary vessels ; Diffusion Magnetic Resonance Imaging ; Female ; Heart surgery ; Humans ; Male ; Middle Aged ; NMR ; Nuclear magnetic resonance ; Postoperative Complications - diagnosis ; Postoperative Complications - pathology ; Prospective Studies ; Severity of Illness Index ; Transplants - surgery</subject><ispartof>Annals of neurology, 2014-09, Vol.76 (3), p.347-355</ispartof><rights>2014 American Neurological Association</rights><rights>2014 American Neurological Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4248-ee8d680bbe0f528b3dc4a5b4bcbfec7792bd0bbb5136e4f8b245a7c5c7187abb3</citedby><cites>FETCH-LOGICAL-c4248-ee8d680bbe0f528b3dc4a5b4bcbfec7792bd0bbb5136e4f8b245a7c5c7187abb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fana.24238$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fana.24238$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25111072$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nah, Hyun-Wook</creatorcontrib><creatorcontrib>Lee, Jae-Won</creatorcontrib><creatorcontrib>Chung, Cheol-Hyun</creatorcontrib><creatorcontrib>Choo, Suk-Jung</creatorcontrib><creatorcontrib>Kwon, Sun U.</creatorcontrib><creatorcontrib>Kim, Jong S.</creatorcontrib><creatorcontrib>Warach, Steven</creatorcontrib><creatorcontrib>Kang, Dong-Wha</creatorcontrib><title>New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors</title><title>Annals of neurology</title><addtitle>Ann Neurol</addtitle><description>Objective
New brain infarcts after coronary artery bypass graft (CABG) are markedly more frequent than clinically evident stroke and have been proposed as a surrogate marker of postprocedural stroke. We sought to investigate the lesion patterns, mechanisms, and predictors of new brain infarction after CABG surgery.
Methods
This was a prospective pre‐ and postoperative brain magnetic resonance imaging (MRI) study in consecutive patients who underwent isolated CABG. Preoperative MRI included diffusion‐weighted imaging (DWI) and magnetic resonance angiography. DWI was repeated on postoperative day 3. Clinical variables, intraoperative findings, and laboratory findings were compared between patients with and without new brain infarcts on DWI.
Results
Of a total of 127 included patients, 35 (27.6%) showed new brain infarcts on DWI. Most lesions were clinically silent, located in the cortical territory (80%), small (<1.5cm) in diameter (89%), and not related to the underlying cerebral arterial abnormality (80%). Old age (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.03–1.15), use of cardiopulmonary bypass (OR = 3.12, 95% CI = 1.13–8.57), a moderate to severe aortic plaque (OR = 21.17, 95% CI = 2.01–222.58), and high levels of high‐sensitivity C‐reactive protein (OR = 1.35, 95% CI = 1.08–1.70) were independent predictors of new brain infarction.
Interpretation
Post‐CABG new brain infarcts are mostly silent and cortically located. Old age, aortic arch atherosclerosis, use of cardiopulmonary bypass, and systemic inflammatory response may contribute to the pathogenesis of post‐CABG new brain infarcts. Ann Neurol 2014;76:347–355</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aortic Diseases - complications</subject><subject>Aortic Diseases - pathology</subject><subject>Atherosclerosis - complications</subject><subject>Atherosclerosis - pathology</subject><subject>Brain Infarction - blood</subject><subject>Brain Infarction - etiology</subject><subject>Brain Infarction - pathology</subject><subject>C-Reactive Protein - analysis</subject><subject>Cardiology</subject><subject>Cardiopulmonary Bypass - adverse effects</subject><subject>Cerebral Cortex - blood supply</subject><subject>Cerebral Cortex - pathology</subject><subject>Confidence intervals</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Diffusion Magnetic Resonance Imaging</subject><subject>Female</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - pathology</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Transplants - surgery</subject><issn>0364-5134</issn><issn>1531-8249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkd9qFDEUh4Modlu98AUk4I2FTpv_k_VuKVqFZYWi1LuQZM6sqTuZaTJDnSfwtU3dtheC4FXIOd_54JwfQq8oOaWEsDMb7SkTjOsnaEElp5VmYvkULQhXopKUiwN0mPM1IWSpKHmODpiklJKaLdCvDdxil2yIOMTWJj9m3Efc2W2EMXicIPfRRg84lFqIW2zbERL2fSr1NGObynfGbh5sznibShvnKW1L8R1eQw7FNtixQDGf4A78dxtD7k6wjQ0eEjTBj33KL9Cz1u4yvLx_j9DXD--_nH-s1p8vPp2v1pUXTOgKQDdKE-eAtJJpxxsvrHTCedeCr-slc03purK0AtFqx4S0tZe-prq2zvEj9HbvHVJ_M0EeTReyh93ORuinbKhUSgvNaf0_KBOcMa0K-uYv9LqfUiyL3FFU0SKUhTreUz71OSdozZDKVdNsKDF3QZoSpPkTZGFf3xsn10HzSD4kV4CzPXAbdjD_22RWm9WDstpPhDzCz8cJm34YVfNamqvNhZFrpb5dXV4awX8D24a4gQ</recordid><startdate>201409</startdate><enddate>201409</enddate><creator>Nah, Hyun-Wook</creator><creator>Lee, Jae-Won</creator><creator>Chung, Cheol-Hyun</creator><creator>Choo, Suk-Jung</creator><creator>Kwon, Sun U.</creator><creator>Kim, Jong S.</creator><creator>Warach, Steven</creator><creator>Kang, Dong-Wha</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201409</creationdate><title>New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors</title><author>Nah, Hyun-Wook ; Lee, Jae-Won ; Chung, Cheol-Hyun ; Choo, Suk-Jung ; Kwon, Sun U. ; Kim, Jong S. ; Warach, Steven ; Kang, Dong-Wha</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4248-ee8d680bbe0f528b3dc4a5b4bcbfec7792bd0bbb5136e4f8b245a7c5c7187abb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aortic Diseases - complications</topic><topic>Aortic Diseases - pathology</topic><topic>Atherosclerosis - complications</topic><topic>Atherosclerosis - pathology</topic><topic>Brain Infarction - blood</topic><topic>Brain Infarction - etiology</topic><topic>Brain Infarction - pathology</topic><topic>C-Reactive Protein - analysis</topic><topic>Cardiology</topic><topic>Cardiopulmonary Bypass - adverse effects</topic><topic>Cerebral Cortex - blood supply</topic><topic>Cerebral Cortex - pathology</topic><topic>Confidence intervals</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Disease - surgery</topic><topic>Coronary vessels</topic><topic>Diffusion Magnetic Resonance Imaging</topic><topic>Female</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - pathology</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Transplants - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nah, Hyun-Wook</creatorcontrib><creatorcontrib>Lee, Jae-Won</creatorcontrib><creatorcontrib>Chung, Cheol-Hyun</creatorcontrib><creatorcontrib>Choo, Suk-Jung</creatorcontrib><creatorcontrib>Kwon, Sun U.</creatorcontrib><creatorcontrib>Kim, Jong S.</creatorcontrib><creatorcontrib>Warach, Steven</creatorcontrib><creatorcontrib>Kang, Dong-Wha</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nah, Hyun-Wook</au><au>Lee, Jae-Won</au><au>Chung, Cheol-Hyun</au><au>Choo, Suk-Jung</au><au>Kwon, Sun U.</au><au>Kim, Jong S.</au><au>Warach, Steven</au><au>Kang, Dong-Wha</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors</atitle><jtitle>Annals of neurology</jtitle><addtitle>Ann Neurol</addtitle><date>2014-09</date><risdate>2014</risdate><volume>76</volume><issue>3</issue><spage>347</spage><epage>355</epage><pages>347-355</pages><issn>0364-5134</issn><eissn>1531-8249</eissn><abstract>Objective
New brain infarcts after coronary artery bypass graft (CABG) are markedly more frequent than clinically evident stroke and have been proposed as a surrogate marker of postprocedural stroke. We sought to investigate the lesion patterns, mechanisms, and predictors of new brain infarction after CABG surgery.
Methods
This was a prospective pre‐ and postoperative brain magnetic resonance imaging (MRI) study in consecutive patients who underwent isolated CABG. Preoperative MRI included diffusion‐weighted imaging (DWI) and magnetic resonance angiography. DWI was repeated on postoperative day 3. Clinical variables, intraoperative findings, and laboratory findings were compared between patients with and without new brain infarcts on DWI.
Results
Of a total of 127 included patients, 35 (27.6%) showed new brain infarcts on DWI. Most lesions were clinically silent, located in the cortical territory (80%), small (<1.5cm) in diameter (89%), and not related to the underlying cerebral arterial abnormality (80%). Old age (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.03–1.15), use of cardiopulmonary bypass (OR = 3.12, 95% CI = 1.13–8.57), a moderate to severe aortic plaque (OR = 21.17, 95% CI = 2.01–222.58), and high levels of high‐sensitivity C‐reactive protein (OR = 1.35, 95% CI = 1.08–1.70) were independent predictors of new brain infarction.
Interpretation
Post‐CABG new brain infarcts are mostly silent and cortically located. Old age, aortic arch atherosclerosis, use of cardiopulmonary bypass, and systemic inflammatory response may contribute to the pathogenesis of post‐CABG new brain infarcts. Ann Neurol 2014;76:347–355</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25111072</pmid><doi>10.1002/ana.24238</doi><tpages>9</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Age Factors Aged Aortic Diseases - complications Aortic Diseases - pathology Atherosclerosis - complications Atherosclerosis - pathology Brain Infarction - blood Brain Infarction - etiology Brain Infarction - pathology C-Reactive Protein - analysis Cardiology Cardiopulmonary Bypass - adverse effects Cerebral Cortex - blood supply Cerebral Cortex - pathology Confidence intervals Coronary Artery Bypass - adverse effects Coronary Artery Disease - surgery Coronary vessels Diffusion Magnetic Resonance Imaging Female Heart surgery Humans Male Middle Aged NMR Nuclear magnetic resonance Postoperative Complications - diagnosis Postoperative Complications - pathology Prospective Studies Severity of Illness Index Transplants - surgery |
| title | New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: Lesion patterns, mechanism, and predictors |
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