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White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting

Journal article
Authors Paulin Andréll
Christer Jensen
Henrik Norrsell
Olof Ekre
Sven Ekholm
Ulf Norrsell
Tore Eliasson
Clas Mannheimer
Christian Blomstrand
Published in The Annals of thoracic surgery
Volume 79
Issue 1
Pages 74-9; discussion 79-80
ISSN 1552-6259 (Electronic)
Publication year 2005
Published at Cardiovascular Institute
Institute of Clinical Neurosciences
Institute of Clinical Neurosciences, Section of Psychiatry
Institute of Selected Clinical Sciences, Department of Radiology
Pages 74-9; discussion 79-80
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Adult, Aged, Aged, 80 and over, Angina Pectoris/surgery/therapy, Brain Ischemia/*etiology/pathology, Carotid Stenosis/complications/ultrasonography, Cerebrovascular Accident/epidemiology/etiology, Cognition Disorders/*etiology/pathology, *Coronary Artery Bypass, Electric Stimulation Therapy, Extracorporeal Membrane Oxygenation/adverse effects, Female, Humans, Ischemic Attack, Transient/epidemiology/etiology, *Magnetic Resonance Imaging, Male, Middle Aged, Myelin Sheath/*pathology, Postoperative Complications/*etiology/pathology, Prospective Studies, Spinal Cord
Subject categories Medical and Health Sciences, Cardiac and Cardiovascular Systems

Abstract

BACKGROUND: The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting. METHODS: The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications. RESULTS: More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications. CONCLUSIONS: Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.

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