Thickened intima of the aortic arch is a risk factor for stroke with coronary artery bypass grafting

Background. Perioperative stroke is one of the most serious complications o f cardiac surgery. Methods. Using transesophageal echocardiography, we estimated the intimal t hickness of the thoracic aorta as an index of the severity of aortic athero sclerosis to determine the risk of stroke in coronary artery bypass graftin g (CABG) patients. The study population comprised 315 consecutive patients who underwent isolated CABG with cardiopulmonary bypass. Results. Five patients (1.6%) had perioperative cerebral stroke or systemic emboli. We compared the mean intimal thicknesses of the ascending aorta, a ortic arch, and descending aorta. Mean thicknesses in patients without stro ke were 2.07 +/- 0.76, 2.78 +/- 1.15, and 2.32 +/- 1.21 mm, respectively, a nd mean thicknesses in the stroke patients were 1.94 +/- 0.55, 6.94 +/- 3.7 9, and 3.39 +/- 1.85 mm, respectively. The patients with an intima of more than 5 mm at the aortic arch had a significantly greater incidence of perio perative stroke (p = 0.007). Conclusions. These results suggest that patients who have an aortic arch in tima thickened to more than 5 mm are at a significantly high risk for perio perative stroke, and thus, the CABG procedure should be carefully evaluated to prevent such complications. (Ann Thorac Surg 2000;70:1565-70) (C) 2000 by The Society of Thoracic Surgeons.