Tag Archives: Coronary circulation

Short-Term Stroke Risk Higher Following CABG Than Post-PCI

Posted on by MaryO

CABG

Among patients with complex coronary artery disease, coronary artery bypass grafting (CABG), as compared to percutaneous coronary intervention (PCI), is associated with a greater risk of periprocedural stroke, but not long-term stroke, according to a new analysis of the SYNTAX trial published on March 20 in JACC Cardiovascular Interventions. At four-year follow-up, there was no difference in stroke incidence between treatments.

The SYNTAX trial randomized 1,800 patients with de novo three-vessel and/or left main coronary disease to CABG or PCI. Overall, 33 and 20 strokes occurred at four years in the CABG and PCI groups, respectively. In the CABG group, nine of the 33 strokes occurred within 30 days of the procedure, whereas 18 of the 20 strokes in the PCI arm occurred more than 30 days after intervention. However, in a multivariate analysis, CABG was not significantly associated with an increased stroke risk (p=0.089).

Lead investigator Michael J. Mack, MD, FACC, Baylor Healthcare System, Plano, Texas, and colleagues concluded, “The overall incidence of stroke was low at four years in the SYNTAX trial in both CABG- and PCI-treated patients. Though more strokes occurred in the CABG arm than in the PCI arm early in the study, no significant differences were found at four years.”

In an accompanying editorial, Jesse Weinberger, MD, Mount Sinai School of Medicine, New York, and Craig Smith, MD, FACC, Columbia University School of Medicine, New York, noted that this analysis reports different stroke rates than the original study where rates were higher with CABG than with PCI (2.2 vs. 0.6 percent, p=0.003). The current analysis, “focused specifically on stroke, reports a stroke difference of 1 percent (CABG) vs. 0.2 percent (PCI) at 0 to 30 days by intent-to-treat (p=0.037), and three of the nine strokes in the CABG group occurred pre-operatively, so a statistically meaningful difference in an as-treated analysis is doubtful,” they wrote.

“The SYNTAX trial was not specifically designed to determine the etiology of stroke in patients treated with CABG or PCI. It is imperative to establish the causes of stroke during CABG and develop strategies to prevent these strokes,” the editorialists concluded. “A prospective study may be warranted.”

From CardioSource – Short Term Stroke Risk CABG PCI.

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Coronary Artery Bypass Graft (CABG off-pump)

Posted on by MaryO
heart with coronary arteries

heart with coronary arteries (Photo credit: Wikipedia)

Before we talk about treatment, let’s start with a discussion about the human body and about your medical condition.

Your doctor has recommended that you have coronary artery bypass surgery. But what does that actually mean?

  • Your heart is located in the center of your chest.
  • It is surrounded by your rib cage and protected by your breastbone.
  • Your heart’s job is to keep blood continually circulating throughout your body.
  • The vessels that supply the body with oxygen-rich blood are called arteries.
  • The vessels that return blood to the heart are called veins.
  • Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood. The arteries that carry this blood supply to the heart muscle are called coronary arteries.
  • Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque.
  • Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger.
  • Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein.
  • Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle.
  • These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.

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Coronary Artery Bypass (CABG) Surgery

Posted on by MaryO
Three coronary artery bypass grafts, a LIMA to...

Three coronary artery bypass grafts, a LIMA to LAD and two saphenous vein grafts – one to the right coronary artery (RCA) system and one to the obtuse marginal (OM) system. (Photo credit: Wikipedia)

Your doctor has recommended that you have coronary artery bypass surgery. But what does that actually mean?

Your heart is located in the center of your chest. It is surrounded by your rib cage and protected by your breastbone. Your heart’s job is to keep blood continually circulating throughout your body.
The vessels that supply the body with oxygen-rich blood are called arteries.

The vessels that return blood to the heart are called veins.
Like any other muscle in the body, the heart depends on a steady supply of oxygen rich blood. The arteries that carry this blood supply to the heart muscle are called coronary arteries.

Sometimes, these blood vessels can narrow or become blocked by deposits of fat, cholesterol and other substances collectively known as plaque.
Over time, plaque deposits can narrow the vessels so much that normal blood flow is restricted. In some cases, the coronary artery becomes so narrow that the heart muscle itself is in danger.

Coronary bypass surgery attempts to correct this serious problem. In order to restore normal blood flow, the surgeon removes a portion of a blood vessel from the patient’s leg or chest, most probably the left internal mammary artery and the saphenous vein.

Your doctor uses one or both of these vessels to bypass the old, diseased coronary artery and to build a new pathway for blood to reach the heart muscle. These transplanted vessels are called grafts and depending on your condition, your doctor may need to perform more than one coronary artery bypass graft.

Of course, operating on the heart is a complex and delicate process and in the case of bypass surgery, your doctor will most likely need to stop your heart before installing the graft.

During the time that your heart is not beating, a special machine, called a heart-lung machine, will take over the job of circulating and oxygenating your blood.

By using this machine, your doctor is able to repair the heart without interfering with the blood flow to the rest of the body.

Following surgery, your heart will be restarted and you will be disconnected from the heart-lung machine