{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T13:52:31Z","timestamp":1740145951884,"version":"3.37.3"},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Severe atherosclerosis of the ascending aorta (SAA) in patients undergoing surgical revascularization by coronary artery bypass grafting (CABG) is becoming an increasing problem as more elderly patients are diagnosed with coronary artery disease. Strokes and other neurologic insults are common complications in this group, with devastating impacts on outcomes and prognoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>Early detection of the atherosclerotic aorta and the application of a stroke prevention protocol will reduce the risk of stroke in patients with SAA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In 2012, we adopted a protocol devised to preemptively detect and manage patients suspected of having SAA. From the time of the application of the protocol, we compared the immediate and late outcomes of CABG in SAA in the 8 years preceding the protocol in a \u201ccontrol\u201d group (30 patients) and in the 8 years following the protocol in a \u201cbrain\u201d group (69 patients).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>More patients with SAA were detected after the initiation of the protocol. They had significantly more history of stroke, renal dysfunction, and left main coronary disease. The percutaneous coronary intervention was utilized more after the protocol (26% vs. 7%) and there was far less utilization of replacement of the ascending aorta (12% vs. 37%). Postoperative stroke rates were significantly less after the protocol (2% vs. 18%), with an almost twofold reduction in stroke associated with SAA even after risk adjustment. The composite endpoints of cardiac death, nonfatal myocardial infarction, and stroke were significantly reduced after initiating the protocol at a median of 2.3 years from the time of revascularization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early detection of SAA and individualized therapeutic strategies for revascularization is effective in reducing athero\u2010embolic brain injury and are associated with better prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23913","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T06:00:47Z","timestamp":1663653647000},"page":"1264-1271","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The brain\u2010before\u2010heart strategy for coronary artery bypass grafting in the severely atherosclerotic aorta: A single\u2010institution experience"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8845-109X","authenticated-orcid":false,"given":"Rakan I.","family":"Nazer","sequence":"first","affiliation":[{"name":"Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine King Saud University Riyadh Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali M.","family":"Albarrati","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Science, College of Applied Medical Science King Saud University Riyadh Kingdom of Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.11.071"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.12945\/j.aorta.2017.17.035"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.25.10.2010"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1051\/ject\/200234129","article-title":"Cerebral emboli during cardiopulmonary bypass: effect of perfusionist interventions and aortic cannulas","volume":"34","author":"Borger MA","year":"2002","journal-title":"J Extra Corpor Technol"},{"key":"e_1_2_9_6_1","first-page":"125","article-title":"Ascending aortic atherosclerosis\u2014a complex and challenging problem for the cardiac surgeon","volume":"2","author":"Bonatti J","year":"1999","journal-title":"Heart Surg Forum"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.15420\/icr.2011.9.2.77"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivr004"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.11.035"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02919664"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.12.040"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0b013e318172b044"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2016.11.009"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-8090-5-14"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23913","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.23913","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.23913","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T16:27:50Z","timestamp":1692462470000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.23913"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,19]]},"references-count":13,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1002\/clc.23913"],"URL":"https:\/\/doi.org\/10.1002\/clc.23913","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"type":"print","value":"0160-9289"},{"type":"electronic","value":"1932-8737"}],"subject":[],"published":{"date-parts":[[2022,9,19]]},"assertion":[{"value":"2022-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}