PROTRUDING AORTIC ATHEROMAS PREDICT STROKE IN ELDERLY PATIENTS UNDERGOING CARDIOPULMONARY BYPASS - EXPERIENCE WITH INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY
PROTRUDING AORTIC ATHEROMAS PREDICT STROKE IN ELDERLY PATIENTS UNDERGOING CARDIOPULMONARY BYPASS - EXPERIENCE WITH INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY
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DOI：
10.1016/0735-1097(92)90139-e
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发表时间：
1992-07-01
影响因子：
24
通讯作者：
KRONZON, I
中科院分区：
文献类型：
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作者：
KATZ, ES;TUNICK, PA;KRONZON, I
通过经食管超声心动图发现的主动脉弓突出的粥样硬化斑块被认为是老年患者中风的一个原因。研究人员对 130 名年龄大于或等于 65 岁的患者进行了术中经食管超声心动图检查，以检测主动脉弓突出的粥样斑块，并确定这些患者是否处于围手术期卒中的较高风险。 130 名患者中有 23 名 (18%) 发现突出的动脉粥样硬化斑块。在这 23 名患者中，有 19 名 (83%) 患者在手术时主动脉弓触诊未发现明显异常。 5 名患者 (4%) 发生围手术期卒中。Logistic 回归确定主动脉弓粥样硬化是预测卒中的唯一历史或手术变量（比值比 5.8，95% 置信区间 1.2 至 27.9，p < 0.03）。外周或脑血管疾病史、主动脉钙化的存在、心脏危险因素、年龄和体外循环持续时间不能预测中风。相比之下，具有可移动成分的突出粥样斑块的患者风险最高。 12 名患有移动性动脉粥样硬化斑块的患者中有 3 名 (25%) 患有中风，而 118 名没有移动性动脉粥样硬化斑块的患者中有 2 名 (2%) 发生中风（卡方 = 10.3，p = 0.001）。通过主动脉弓插管或从插管尖端发出的高压射流使脆弱、突出的动脉粥样硬化物质移位和脱离，可能在形成中风的过程中发挥重要作用。栓塞和中风。
Protruding atheromas of the aortic arch identified by transesophageal echocardiography have been implicated as a cause of stroke in elderly patients. One hundred thirty patients greater-than-or-equal-to 65 years of age were studied with intraoperative transesophageal echocardiography to detect aortic arch protruding atheromas and determine if these patients were at higher risk for perioperative stroke. Protruding atheromas were identified in 23 (18%) of 130 patients. In 19 (83%) of these 23 patients, palpation of the aortic arch at operation did not identify significant abnormalities. Five patients (4%) had perioperative stroke.Logistic regression identified aortic arch atheroma as the only historical or procedural variable that was predictive of stroke (odds ratio 5.8, 95% confidence interval 1.2 to 27.9, p < 0.03). A history of peripheral or cerebrovascular disease, presence or aortic calcification, cardiac risk factors, age and duration of cardiopulmonary bypass did not predict stroke. In contrast, patients with protruding atheromas with mobile components were at highest risk. There were 3 (25%) of 12 patients with a mobile atheroma who had a stroke versus 2 (2%) of 118 patients without a mobile atheroma (chi-square = 10.3, p = 0.001).Displacement and detachment of the frail, protruding atherosclerotic material by aortic arch cannulation or by the high pressure jet emanating from the cannula tip may play an important role in the creation of embolization and stroke.