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Subclinical Cerebral Complications After Coronary Artery Bypass Grafting
Prospective Analysis With Magnetic Resonance Imaging, Quantitative Electroencephalography, and Neuropsychological Assessment
Ritva Vanninen, MD;
Marja Äikiä, MSc;
Mervi Könönen, MSc;
Kaarina Partanen, MD;
Harri Tulla, MD;
Päivi Hartikainen, MD;
Juhani Partanen, MD;
Hannu Manninen, MD;
Pentti Enberg, MD;
Mikko Hippeläinen, MD
Arch Neurol. 1998;55:618-627.
Objective To analyze the frequency and severity of subclinical cerebral complications associated with coronary artery bypass grafting (CABG).
Design A prospective controlled study using preoperative and postoperative magnetic resonance imaging (MRI) of the brain, quantitative electroencephalography (QEEG), and detailed neuropsychological and neurologic examinations as potentially sensitive indicators of subclinical cerebral injury associated with CABG.
Setting Multimodality evaluation in a tertiary care unit (Kuopio University Hospital, Kuopio, Finland).
Patients Thirty-eight patients undergoing elective CABG and 20 control patients undergoing other major vascular surgery, mostly operations on the abdominal aorta.
Main Outcome Measures Coronary artery bypass grafting–associated cerebral complications assessed preoperatively and postoperatively by brain MRI, QEEG, detailed neurologic examination, and a neuropsychological test battery that evaluates cognitive functions in major areas known to be vulnerable to organic impairment (learning and memory, attention, flexible mental processing, and psychomotor speed).
Results There were no major neurologic complications. A mild hemisyndrome developed in 1 patient who underwent CABG and in 1 control patient. Overall, there was no decline in mean cognitive performance 3 months after surgery. Electroencephalographic slowing of 0.5 Hz or more in at least 2 channels occurred in 11 patients who underwent CABG and in 1 control patient (P=.03). The postoperative brain MRI scan revealed new small ischemic lesions in 8 patients (21%) in the CABG group but in none of the control group (P=.03). These new cerebral MRI lesions did not explain deterioration in neuropsychological test performance or the QEEG slowing.
Conclusions Coronary artery bypass grafting causes more QEEG alterations and small ischemic cerebral lesions that are detectable by MRI than does other major vascular surgery. The effect is mainly subclinical, because no statistically significant deterioration in mean neuropsychological test performance was detected.
From the Departments of Clinical Radiology (Drs Vanninen, K. Partanen, and Manninen), Neurology (Ms Äikiä and Drs Hartikainen and Enberg), Clinical Neurophysiology (Ms Könönen and Dr J. Partanen), and Surgery (Drs Tulla and Hippeläinen), Kuopio University Hospital, Kuopio, Finland.
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