Can near infrared spectroscopy predict stroke in coronary artery by-pass graft?

Year 2022, , 362 - 367, 22.10.2022

Serkan Ketenciler , Hüseyin Gemalmaz , Yıldırım Gültekin

https://doi.org/10.38053/acmj.1140522

Abstract

Aim: Central nervous system may be affected after coronary artery by-pass graft (CABG) and carotid artery stenosis is an important risk factor. Near infrared spectroscopy (NIRS) is used to measure the regional cerebral oxygen concentration (rScO2). The aim of this study is to determine the relationship of rScO2 in patients with carotid artery lesion and to determine the relation of stroke with rScO2 changes.
Material and Method: The patients who had cardiac bypass surgery were involved in the study. Demographic characteristics and presence of carotid artery stenosis, were collected from the files. Bilateral rSO2 measurements performed by 2 sensors. RScO2 values are detected in 5 minutes of cross-clamp (XCL5), XCL30, XCL60, XCL90, XCL120 and after the by-pass.
Results: 57 patients were involved in the study (40 male and mean age 62.54±13.08). 17 (29%) patients had carotid stenosis. rScO2 levels are statistically significantly decreased in the patients with stenosis after post-clamp 30 minutes. Three patients had stroke after surgery (5.2%). Two of the patients had carotid stenosis while one patient did not have.
Conclusion: RScO2 decreased in carotid artery stenosis irrespective of the degree of the stenosis after 30 minutes of cross-clamp. Cerebral perfusion follow-up is important during the CPB and NIRS is a method that can be used for this purpose.

Keywords

Coronary artery by-pass graft, carotid artery stenosis, near infrared spectroscopy

Project Number

YOK

References

• Gültekin Y, Bolat A. Results of the first 200 open heart surgeries performed in a university hospital clinic: Kırıkkale University, Faculty of Medicine, Cardiovascular Surgery. KÜ Tıp Fak Derg 2020; 22: 348-56.
• De Feo M, Renzulli A, Onorati F, et al. The risk of stroke following CABG: one possible strategy to reduce it? Int J Cardiol 2005; 98: 261-6.
• Bruggemans EF. Cognitive dysfunction after cardiac surgery: pathophysiological mechanisms and preventive strategies. Neth Heart J 2013; 21: 70-3.
• Mitchell SJ, Merry AF. Perspective on cerebral microemboli in cardiac surgery: significant problem or much ado about nothing? J Extra Corpor Technol 2015; 47: 10-5.
• Bevan PJ. Should cerebral near-infrared spectroscopy be standard of care in adult cardiac surgery? Heart Lung Circ 2015; 24: 544-50.
• Lassnigg A, Hiesmayr M, Keznickl P, et al. Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: Effects of hemodilution, temperature, and flow. J Cardiothorac Vasc Anesth 1999; 13: 544–8.
• Sung TY, Kang WS, Han SJ, et al. Does near-infrared spectroscopy provide an early warning of low haematocrit following the initiation of hypothermic cardiopulmonary bypass in cardiac surgery? J Int Med Res 2011; 39: 1497–503.
• Naylor AR, Mehta Z, Rothwell PM, Bell PR. Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. Eur J Vasc Endovasc Surg 2002; 23: 283-94.
• Mettananda KCD, Eshani MDP, Wettasinghe LM, et al. Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients. BMC Neurol 2021; 21: 385-91.
• Gold JP, Charlson ME, Williams-Russo P, et al. Improvement of outcomes after coronary artery bypass: A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 1995; 110: 1302-11.
• Heringlake M, Garbers C, Kabler JH, et al. Preoperative cerebral oxygen saturation and clinical outcomes in cardiac surgery. Anesthesiology 2011; 114: 58-69.
• Murkin JM. NIRS: A standard of care for CPB vs. an evolving standard for selective cerebral perfusion? J Extra Corpor Technol 2009; 41: 11-4.
• Zacharias DG, Lilly K, Shaw CL, et al. Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery. J Cardiothorac Vasc Anesth 2014; 28: 308-16.
• Harrington DK, Walker AS, Kaukuntla H, et al. Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial. Circulation 2004; 110: 231-6.
• Coskun C, Borulu F, Emir I, Hanedan M, Mataraci I. Investigation of the Relationship between cerebral near-ınfrared spectroscopy measurements and cerebrovascular event in coronary artery bypass grafting operation in patients without carotid stenosis and patients with carotid stenosis below surgical margins. Braz J Cardiovasc Surg 2020; 35: 465-70.
• Senanayake E, Komber M, Nassef A, Massey N, Cooper G. Effective cerebral protection using near-infrared spectroscopy monitoring with antegrade cerebral perfusion during aortic surgery. J Card Surg. 2012; 27: 211-6.
• Lin HH, Liao SF, Wu CF, et al. Outcome of frozen elephant trunk technique for acute type A aortic dissection: As systematic review and meta-analysis. Medicine (Baltimore) 2015; 94: 694-703.
• Bayram H, Hidiroglu M, Cetin L, et al. Comparing S-100 beta protein levels and neurocognitive functions between patients undergoing on-pump and off-pump coronary artery bypass grafting. J Surg Res 2013; 182: 198-202.
• Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763-816.
• Patel N, Banahan C, Janus J, et al. Neurological impact of emboli during adult cardiac surgery. J Neurol Sci 2020; 15: 416-24.
• Drakopoulou M, Oikonomou G, Soulaidopoulos S, Toutouzas K, Tousoulis D. Management of patients with concomitant coronary and carotid artery disease. Expert Rev Cardiovasc Ther 2019; 17: 575-83.
• Naylor AR, Ricco JB, de Borst GJ, et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 3-81.
• Özyalçın S, Diken Aİ, Yalçınkaya A, Türkmen U. Carotid artery stenosis in asymptomatic patients undergoing coronary artery bypass grafting: who and when should be screened? Kardiol Pol. 2021; 79: 25-30.
• Bartels K, McDonagh DL, Newman MF, Mathew JP. Neurocognitive outcomes after cardiac surgery. Curr Opin Anaesthesiol 2013; 26: 91-7.
• Udzik J, Biskupski A, Szylińska A, Kowalska Z, Listewnik M. Percentage of hematocrit decrease after the initiation of cardiopulmonary bypass—clinical implications and affecting factors. Rev Cardiovasc Med. 2021; 22: 1563-8.
• Onur T, Karaca Ü, Ata F, et al. Intraoperative hyperoxygenation may negatively affect postoperative cognitive functions in coronary artery bypass graft operations: A randomized controlled study. J Card Surg. 2022; 37: 2552-63.
• Murkin JM, Arango M. . Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 2009; 103: 3-13.
• Sungurtekin H, Boston US, Cook DJ. Bypass flow, mean arterial pressure, and cerebral perfusion during cardiopulmonary bypass in dogs. J Cardiothorac Vasc Anesth 2000; 14: 25-8.
• Tufo HM, Ostfeld AM, Shekelle R. Central nervous system dysfunction following open-heartsurgery. JAMA 1970; 212: 1333-40.
• Coskun C, Borulu F, Emir I, Hanedan M, Mataracı I. Investigation of the relationship between cerebral near-infrared spectroscopy measurements and cerebrovascular event in coronary artery bypass grafting operation in patients without carotid stenosis and patients with carotid stenosis below surgical margins. Braz J Cardiovasc Surg. 2020; 35: 465-70.
• Cai J, Tang M, Gan X. Meta-analysis of perioperative stroke and mortality in CABG patients with carotid stenosis. Neurologist 2021; 26: 116-24.
• Edmonds HL, Sehic A, Pollock SB, et al. Lowcerebrovenous oxygen saturatıon predicts disorientation. Anesthesiology 1998; 89: 941- 8.