Page 748

Karger_ESC London_2013

22. European Stroke Conference 761 Stroke prevention Consistent reduction of post Coronary Artery Bypass Grafting delirium frequency by the Haga Braincare Strategy . R.W. Keunen1, W.A. Palmbergen2, A. van Sonderen3, M.A. Falsafi4, F Duynstee5, K Claessen6 Haga Teaching Hospitals, The Hague, THE NETHERLANDS1-6 Background to reduce the frequency of the ischemic cerebral complications after CABG we intro-duced in 2008 the Haga Braincare Strategy 1. The HBS consists of a preoperative check of ce-rebral hemodynamics followed by non-invasive cerebral oximetry during and after surgery untill the patient is awake and hemodynamically stable at the ICU. Main ischemic cerebral events after CABG consists of hemodynamic strokes (due to occluded carotid arteries in combination with poor collaterals) and delirium (related to silent peri-operative ischemia). This report shows the consecu-tive delirum frequency of 1446 patients during 46 months. Methods During the first 12 months we did not implement the HBS. After 12 months we implement-ed the HBS. Preop TCD (EMS-9UTM/Delicate/China) was performed by nursepractioners; in case of abnormal cerebral hemodynamics (less that 2 % of the patients) carotid artery angioplasthy was performed to restore cerebral flow. If this procedure was not possible patients were subjected to mild hypothermia during surgery. In case of a 20 % dropp of oxygen during CABG, cerebral flow was restored immediately (often by increasing pumpflow). INVOS/Covidien/USA was used for cerebral oxymetry. Results the delirum frequency during the first 12 month was 13.3 %; the frequency gradually dropp significantly after implementation to 3.0 % after 46 months (p < 0.019). (see graph). The HBS was an independ predictor of a reduced delium rate (odd ratio = 0.37, P < 0.021). Conclusion The Haga Braincare Strategy reduced significantly the delirium rate after CABG. Reference 1 Palmbergen W. et al Improved perioperative neurological monitoring of coronary artery bypass graft patients reduces the incidence of postoperative delirium: the Haga Brain Care Strategy Interac-tive CardioVascular and Thoracic Surgery 0 (2012) 1–7 (doi:10.1093/icvts/ivs317) 748 © 2013 S. Karger AG, Basel Scientific Programme 762 Stroke prevention Incidence Of Stroke Associated With Thyroid Disease In HASU Patients L. Al-Dhahir1, M.N. Baig2, S.S. Ghatore3 Queens Hospital Barking Havering And Redbridge NHS Trust, London, UNITED KING-DOM1, Queens Hospital Barking Havering And Redbridge NHS Trust, London, UNITED KING-DOM2, Queens Hospital Barking Havering And Redbridge NHS Trust, London, UNITED KING-DOM3 Undiagnosed and undertreated hypothyroidism can cause elevated total-chol, LDL-cholesterol and Triglycerides increasing the risk of cardiovascular mortality ( 1 ). However over treated hypothy-roidism to the point of subclinical hyperthyroidism can also increase the risk of ischaemic stroke due to atrial fibrillation as a result of low TSH. Atrial fibrillation is the most common arrhythmia and a potential risk for developing strokes ( 2 ). We conducted a small prospective cohort study in-volving 126 stroke admissions over a period of 32 days in our Hyper Acute Stroke unit . Of the 126 patients 20 patients were hypothyroid, 76% of the candidates were female, 59% had normal sinus rhythm, and 71% had a TSH <5mU. Only 25% of patients admitted to HASU with strokes and known hypothyroidism had their TSH checked on admission. There were 18 hypothyroid patients who were on some dose of levothyroxine pre morbidly. We found that patients who were over treated with levothyroxine had subclinical hyperthyroidism as a result were at higher risk of AF and consequently ischemic stroke. were undertreated, making them more dyslipidaemic and prone to strokes. With the findings of this study, we recommend thyroid function test and lipid tests to be performed as a mandatory procedure for all stroke patients with atrial fibrillation, dysfunctional thyroid disease or signs of thyroid disorder. The benefits of admin-istering of Aspirin to all hypothyroid patients as primary prevention to prevent ischemic stroke re-quires further investigation. References: 1.The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population co-hort study BMJ 2012;345:e7895 2. 2.Prevalence of Diagnosed Atrial Fibrillation in AdultsNational Implications for Rhythm Manage-ment and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study JAMA. 2001;285(18):2370-2375. doi:10.1001/jama.285.18.2370


Karger_ESC London_2013
To see the actual publication please follow the link above