Brain magnetic resonance angiography-based strategy for stroke reduction in coronary artery bypass grafting

Abstract

We have been using magnetic resonance angiography (MRA) preoperatively to identify patients at increased risk of stroke in coronary artery bypass grafting (CABG). Based upon the intracranial MRA findings, either the off-pump or the on-pump procedure was selected. We report the results of our MRA-based strategy of CABG in 140 consecutive patients. Intracranial arterial lesions were found in 90 patients (64%). The most affected arteries were internal carotid (48%), followed by vertebral (18%) and middle cerebral (16%). Using the MRA score describing the severity of intracranial atherosclerosis, 35 patients with a score of ≥5 underwent off-pump, while 105 patients with a score of <5 underwent on-pump CABG. In the off-pump group, the patient age was older, the incidence of abnormal preoperative brain CT was higher, and the MRA score was higher (6.0 ± 1.1 vs. 1.2 ± 1.3 points) than in the on-pump groups. Even though the risk was higher in the off-pump group, the clinical outcomes were not significantly different, including the hospital mortality and the incidence of stroke and additional coronary intervention. In conclusion, the brain MRA-based selection of off-pump CABG can contribute to prevention of stroke in neurologically high-risk patients.