跳至主要内容

Impact of Perioperative Management for Intracranial Arterial Stenosis on Postoperative Stroke Incidence in Coronary Artery Bypass Surgery

In general, intracranial arterial steno-occlusive lesion (IAS) is known as the most common cause of stroke. Previous studies demonstrated that the prevalence of IAS was equal to or even higher than that of extracranial carotid lesions in patients undergoing coronary artery bypass grafting (CABG) and that its severity was parallel to the number of diseased coronary arteries. A large-scale study showed that total assessment of CVD using magnetic resonance imaging and angiography (MRI/A) was the most useful method to predict perioperative stroke in patients undergoing CABG. Nevertheless, IAS is not routinely evaluated preoperatively in many patients undergoing CABG. In this paper, the authors hypothesized that adequate perioperative management for IAS is useful to prevent stroke in CABG. 

IAS was evaluated using magnetic resonance imaging/angiography (MRI/A, n = 216) in patients without a history of stroke or carotid stenosis (≥50%) in CABG between May 2005 and June 2018 (n = 424). Off-pump CABG was performed in most patients. Different perioperative managements of systolic arterial pressure (SAP) were applied for patients with and without MRI/A. SAP was strictly maintained at ≥80 mmHg in patients with significant IAS (≥50%, n = 28) and ≥90 mmHg for severe IAS (≥70%, n = 44) while SAP less than 80 mmHg (usually ≥70 mmHg) was allowed for patients without MRI/A. Intra-aortic balloon pumping was used for patients with multiple severe IAS and/or occlusion. Clinical outcomes were compared between patients with and without MRI/A. Propensity matching was performed (n = 181 each). 

Complete revascularization was achieved in all patients. Nine patients (2.12%) had postoperative strokes; the incidence of stroke was signifi-cantly less in patients with preoperative MRI/A (n = 1, p = 0.016). There was no significant difference in the incidence of in-hospital mortality between patients with and without preoperative MRI/A (0.5% and 1.0%, respectively; p = 0.529). Multivariate analysis revealed that no preoperative MRI/A was the only significant predictors of postoperative stroke (p = 0.045). The incidence of stroke was not higher in patients with IAS who underwent MRI/A (p = 0.332). 

In summary, in this study, the preoperative evaluation of intracranial atherosclerosis using MRI/A and following our perioperative management for patients with IAS markedly decreased the incidence of perioperative stroke in patients undergoing CABG. Because most strokes occurred in the distal area of IAS, IAS could be a crucial cause of perioperative stroke. Therefore, we recommend preoperative brain MRI/A for patients with high risk of cerebrovascular atherosclerosis in CABG.


Article by Hajime Imura, et al, from Japan.

Full access: http://suo.im/4EkR2R

评论

发表评论

此博客中的热门博文

Does Immigration Promote the Investment of the Monopolistic Firm?

In the present paper, we examine the effect of increasing uncertainty of immigrants’ growth on the optimal timing of investment of a firm that has a monopolistic power over the labor market. It is revealed that when the uncertainty of immigrants’ growth is more than a threshold level, increasing uncertainty of immigrants’ growth accelerates the optimal timing of firms’ investment and enhances the economic growth, even if the uncertainty of immigrants’ growth is formulated by the geometric Brownian motion, which is in sharp contrast to the standard result that an increase in the uncertainty postpones the optimal timing. With an increase in the immigrants over the past ten years, workforces in the host countries have been growing significantly to the extent that the immigrants represent 70% of the increase in the workforce in Europe, and 47% in the United States as OECD indicates. In the present paper, we attempted to investigate the effect of increased uncertainty caused by the growi...
发表评论
阅读全文

Education Policy Implementation: A Mechanism for Enhancing Primary Education Development in Zanzibar

Education is one of the fundamental rights of individuals; therefore, the government of a country needs to develop and strengthen educational policy and quality as well as to ensure that everyone has equal access to basic education. The improvement of access and quality of education in the world is becoming as an essential factor in development, whereas the basic education (primary school), is acknowledged as a foundation of the higher educational development for every country. To fulfill this goal, governments introduce several policies and procedures; however, it requires some reforms and participation from the politician, policymakers, and other stakeholders to re-examine educational policy so that it can lead to multiplication and betterment of the reforms. Educational reforms actually focus on accountability. A positive educational development and reform is very challenging and needs more effort and strategy on how to use and utilize the resources effectively as such it can achie...
发表评论
阅读全文

Electron Spin and Proton Spin in the Hydrogen and Hydrogen-Like Atomic Systems

Read full paper at: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52202#.VIj7tMnQrzE Author(s) Stanisław Olszewski * Affiliation(s) Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland . ABSTRACT The mechanical angular momentum and magnetic moment of the electron and proton spin have been calculated semiclassically with the aid of the uncertainty principle for energy and time. The spin effects of both kinds of the elementary particles can be expressed in terms of similar formulae. The quantization of the spin motion has been done on the basis of the old quantum theory. It gives a quantum number n = 1/2 as the index of the spin state acceptable for both the electron and proton ...
发表评论
阅读全文