Obusez Emmanuel C, Svensson Lars, Bullen Jennifer, Obuchowski Nancy, Jones Stephen E
Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Thoracic and Cardiovascular Surgery, Center for Aortic Surgery, Marfans Syndrome and Connective Tissue Disorder Clinic, Heart and Vascular Institute; Cleveland Clinic, Cleveland, Ohio.
J Card Surg. 2018 Sep;33(9):552-560. doi: 10.1111/jocs.13786. Epub 2018 Sep 2.
Postoperative brain injury is a cause of mortality and morbidity in patients who undergo thoracic aortic replacement. Chronic microvascular white matter ischemic change (WMIC) has been shown to be associated with acute brain infarction in the general population. WMIC has also been shown to be an independent predictor of non-focal neurocognitive changes, generalized seizures, and temporary neurologic dysfunction in patients who undergo thoracic aortic replacement. The aim of this study is to determine if WMIC is a risk factor for acute brain infarction in patients who undergo thoracic aortic replacement.
A case-control study of patients who underwent thoracic aortic replacement between 2001 and 2014 were reviewed for neurological changes after surgery and acute brain infarction on postoperative diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI). Patients with neurological changes were matched with control patients who underwent thoracic aortic replacement and had postoperative neurological symptoms without acute brain infarctions. Acute infarction was re-assessed by reviewing DWI sequences on postoperative MRI. WMIC was assessed on FLAIR and T2WI sequences on both preoperative and postoperative MRI. Logistic regression was performed assessing the relationship of WMIC and acute ischemic infarction.
5171 patients underwent thoracic aortic replacement; 179 had postoperative neurological changes, and of those 53 patients had acute brain infarction on postoperative DWI. Patients with deep WMIC were more likely to have acute DWI infarctions after thoracic aortic replacement (P = 0.023).
Our matched retrospective case-controlled study shows deep WMIC to be a predictor of acute brain infarction on DWI after thoracic aortic replacement.
术后脑损伤是接受胸主动脉置换术患者死亡和发病的一个原因。慢性微血管白质缺血性改变（WMIC）已被证明与普通人群中的急性脑梗死有关。WMIC也已被证明是接受胸主动脉置换术患者非局灶性神经认知改变、全身性癫痫发作和暂时性神经功能障碍的独立预测因素。本研究的目的是确定WMIC是否是接受胸主动脉置换术患者急性脑梗死的危险因素。
对2001年至2014年间接受胸主动脉置换术的患者进行病例对照研究，回顾术后的神经学变化以及术后弥散加权成像（DWI）磁共振成像（MRI）上的急性脑梗死情况。有神经学变化的患者与接受胸主动脉置换术且术后有神经学症状但无急性脑梗死的对照患者进行匹配。通过回顾术后MRI上的DWI序列对急性梗死进行重新评估。在术前和术后MRI的液体衰减反转恢复序列（FLAIR）和T2加权成像（T2WI）序列上评估WMIC。进行逻辑回归分析以评估WMIC与急性缺血性梗死之间的关系。
5171例患者接受了胸主动脉置换术；179例有术后神经学变化，其中53例在术后DWI上有急性脑梗死。深部WMIC的患者在胸主动脉置换术后更有可能出现急性DWI梗死（P = 0.023）。
我们的匹配回顾性病例对照研究表明，深部WMIC是胸主动脉置换术后DWI上急性脑梗死的一个预测因素。
