Plaques in Aortic Arch Predict Ischemic Brain Injury After Cardiac Surgery

Mild to moderate atheromatous disease in the ascending aorta is associated with an increased risk of ischemic brain infarcts after cardiac surgery, according to a report published in the September issue of Stroke.

The findings are based on a study of 110 patients who had their proximal thoracic aorta evaluated with echocardiography and epiaortic scanning during cardiac surgery. The subjects were divided into high- and low-risk groups based on an intimal thickness of greater or no greater than 2 mm, respectively.

A few days after surgery, diffusion-weighted MRI was performed to identify new ischemic brain infarcts, Dr. George Djaiani, from Toronto General Hospital, and colleagues note.

Subjects in the high-risk group averaged 71 years of age, significantly older than the mean 67 years in the low-risk group. In addition, high-risk patients were more likely to have left ventricular dysfunction.

Overall, 61.5% of high-risk patients had MRI-detected brain lesions compared with 0% of low-risk patients (p < 0.0001). Confusion was noted in 16% of high-risk patients, but in only 7% of the low-risk group. The median embolic count was also much higher in the high-risk group -- 223.5 vs. 70.0 (p = 0.003) -- and correlated with confusion scores. "Patient stratification based on the aortic atheromatic burden should be addressed in future trials designed to tailor treatment strategies to improve long-term outcomes of coronary heart disease and reduce the risks of perioperative neurologic injury," the authors conclude.