Author + information
- Received July 27, 2010
- Revision received December 8, 2010
- Accepted December 15, 2010
- Published online May 3, 2011.
- Eun-Jae Lee, MD⁎,
- Kyoung-Hyo Choi, MD†,
- Ju-Seok Ryu, MD‡,
- Sang-Beom Jeon, MD⁎,
- Seung-Whan Lee, MD§,
- Seong-Wook Park, MD§,
- Seung-Jung Park, MD§,
- Jae-Won Lee, MD∥,
- Suk-Jung Choo, MD∥,
- Cheol-Hyun Chung, MD∥,
- Sung-Ho Jung, MD∥,
- Dong-Wha Kang, MD⁎,
- Jong S. Kim, MD⁎ and
- Sun U. Kwon, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Sun U. Kwon, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul 138-736, South Korea
Objectives We aimed to define the relationship between cerebral atherosclerosis and stroke after coronary artery bypass grafting (CABG).
Background Although cerebral atherosclerosis may play a crucial role in the advent of post-CABG stroke, only extracranial carotid artery disease has been extensively studied, and the effects of atherosclerosis on the mechanisms underlying post-CABG stroke remain unclear.
Methods Pre-operative magnetic resonance angiography was performed on 1,367 consecutive CABG patients to assess intracranial and extracranial cerebral atherosclerosis. Disease severity was evaluated by atherosclerosis score, as determined by the number of steno-occlusions of cerebral arteries and the degree thereof. Post-CABG strokes (within 14 days) were classified as atherosclerotic (strokes attributable to pre-defined atherosclerosis) or other (strokes caused by other mechanisms). Associations between post-CABG stroke and each type of atherosclerotic disease (extracranial carotid artery disease, intracranial, extracranial, or extracranial and/or intracranial cerebral atherosclerosis), differentiated according to the involved arteries, were analyzed.
Results Stroke occurred in 33 patients, and the atherosclerosis score was independently associated with stroke development (odds ratio: 1.35; 95% confidence interval: 1.16 to 1.56). Atherosclerotic stroke was defined in 15 (45%), and constituted >40% of both immediate (within 24 h) and delayed strokes. Intracranial, extracranial, and extracranial and/or intracranial cerebral atherosclerosis were significantly associated with stroke.
Conclusions Cerebral atherosclerosis was closely related to the occurrence of post-CABG stroke, being both an independent risk factor for and the cause of a significant proportion of strokes. Pre-operative evaluation of intracranial and extracranial cerebral arteries, apart from the extracranial carotid artery, may be useful to predict the likelihood of post-CABG stroke.
This study was supported by a grant (A060171) from the Korea Health 21 Research and Development Project, Ministry of Health, Welfare, and Family Affairs, Republic of Korea. The authors have reported that they have no relationships to disclose.
- Received July 27, 2010.
- Revision received December 8, 2010.
- Accepted December 15, 2010.
- American College of Cardiology Foundation