Determination of Etiologic Mechanisms of Strokes Secondary to Coronary Artery Bypass Graft Surgery

Likosky, Donald S.; Marrin, Charles A.S.; Caplan, Louis R.; Baribeau, Yvon R.; Morton, Jeremy R.; Weintraub, Ronald M.; Hartman, Gregg S.; Hernandez, Felix; Braff, Steven P.; Charlesworth, D.; Malenka, David J.; Ross, Cathy S.; O’Connor, Gerald T.

doi:10.1161/01.str.0000098650.12386.b3

Cited by 259 publications

(172 citation statements)

References 22 publications

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“…Our single-center, retrospective review of cardiac operations during a 10-year period found that stroke complications were infrequent. The overall stroke rate of 2.8% is similar to that reported in other studies [3][4][5][6][7][8][9][10]19].…”

Section: Commentsupporting

confidence: 88%

“…This differentiation was determined before the data were collected and was based on our specific institutional experience as well as previous reports that a significant proportion of postoperative strokes occur within the first 24 hours after CPB [10,19]. All stroke time data were reviewed by 3 investigators, and the temporal onset of the deficits was classified by consensus as either occurring within 24 hours from the onset of the procedure (≤24-hour group) or after 24 hours from the onset of the operation (>24-hour group).…”

Section: Classification Of Timing Of Strokementioning

confidence: 99%

“…Many authors agree that strokes after the use of CPB are largely the result of hypoperfusion injury or thromboembolic insults [11,19,20]. Very few strokes, if any, in the post-CPB setting are the result of hemorrhage alone.…”

Section: Commentmentioning

confidence: 99%

“…Studies of the timing of stroke in the postoperative setting have been published [7,10,19,20]. To our knowledge, no studies to date have specifically addressed the relationship of stroke timing after CPB and neurologic outcomes.…”

mentioning

confidence: 99%

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Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Lisle¹,

Barrett²,

Gazoni³

et al. 2008

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 88%

Section: Classification Of Timing Of Strokementioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Lisle¹,

Barrett²,

Gazoni³

et al. 2008

The Annals of Thoracic Surgery

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show abstract

“…47,59 Between 30-50% of perioperative strokes detected with brain imaging are due to cerebral macroembolism likely arising from the ascending aorta. 10,28,45,64,101 Encephalopathy and neurocognitive dysfunction are believed to result primarily from cerebral microembolism.. 3,18 ,20, 47,57,73,82,84,92 Microemboli are either gaseous or particulate in composition. Gaseous emboli can arise form an open left-sided cardiac chamber or from air entrained into the CPB circuit.…”

Section: Cerebral Embolismmentioning

confidence: 99%

Mechanisms of Cerebral Injury from Cardiac Surgery

Hogue

Gottesman

Stearns

2008

Critical Care Clinics

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Cerebral injury is a frequent complication of cardiac surgery and has been associated with high mortality, morbidity, hospital costs, and an increased likelihood of admission to a secondary care facility after hospital discharge, and impaired quality of life. 47,71,78,86 There are a variety of manifestations of perioperative cerebral injury including ischemic (or, less commonly, hemorrhagic) stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients, and neurocognitive dysfunction affecting 20% to 30% of patients one month after surgery. 47,71,78,86 The range in reported incidences between studies is likely due to different patient populations (e.g., patient age and risk status, types of procedures), diagnostic definitions, and the intensity of clinical surveillance. Contemporary studies using sensitive brain MRI with diffusion weighted imaging report that as many as 45% of patients who have undergone cardiac surgery have new ischemic brain lesions that are often clinically undetected. 47,63The prevailing hypothesis, though not definitively proven, is that all forms of injury associated with cardiac surgery (i.e., stroke, encephalopathy, and neurocognitive dysfunction) have a similar etiology and that the manifestations depend on the extent and location of brain injury (e.g., motor cortex vs. areas subserving cognition). Many earlier studies that have described long-term neurocognitive changes after cardiac surgery have failed to include a non-surgical control group. 47,79 In a longitudinal study of patients with coronary artery disease undergoing either percutaneous coronary interventions or coronary artery bypass grafting (CABG), there were no differences in cognitive measures 36 months after either procedure. 88 These data imply that the effects of cardiac surgery on cognition may be short-lived (i.e., ~ 3 mo) and that progression of inherent cerebral vascular disease is a more important determinant of long-term cognitive decrements. These results further underscore the low sensitivity and specificity of psychometric testing for detecting cerebral injury in elderly populations with a high prevalence of preexisting cognitive impairment. 47In this paper, we will examine postulated mechanisms for cerebral injury from cardiac surgery. Most emphasis has been placed in the past on the intraoperative interval as being the period of highest cerebral vulnerability. Many clinical cerebral events, however, occur in the postoperative period. We have reported, in fact, that > 20% of clinical strokes occur after recovery from surgery and anesthesia. 45,71 Thus, patients must be considered vulnerable to cerebral injury any time during the perioperative period.

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Carotid Endarterectomy or Stenting Before Coronary Surgery?

Roach

2008

Arch Neurol

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Determination of Etiologic Mechanisms of Strokes Secondary to Coronary Artery Bypass Graft Surgery

Cited by 259 publications

References 22 publications

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Timing of Stroke After Cardiopulmonary Bypass Determines Mortality

Mechanisms of Cerebral Injury from Cardiac Surgery

Carotid Endarterectomy or Stenting Before Coronary Surgery?

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