Incidence and predictors of postoperative ischemic stroke after coronary artery bypass grafting

Abstract

Although coronary artery bypass grafting (CABG) has been shown to be safe and effective in appropriately selected patients, 1,2 ischemic stroke is a potentially devastating complication that is associated with increased risk of both short-and long-term morbidity and mortality. 3,4 The most common mechanism of stroke following CABG is related to emboli originating from the ascending aorta during cross-clamping, cannulation, and creation of proximal anastomoses; however, intracardiac thrombi, hypoperfusion, and air emboli have all been implicated as possible causes. 5 Thus, in light of this complex and multifactorial pathophysiology, several risk factors

Invited commentary on “Risk factors for cerebrovascular accident after isolated coronary artery bypass grafting in Veterans”

“…Contrary to existing literature, 3,4 this study did not show peripheral vascular disease (PVD) as a significant risk factor for postoperative CVA. The authors contributed this to the definition of PVD within VASIP which included patients who have previously undergone peripheral revascularization.…”

Does Dexmedetomidine Reduce the Risk of Atrial Fibrillation and Stroke After Adult Cardiac Surgery? A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…42 Risk factors of postoperative stroke include advanced age, diabetes mellitus, cerebrovascular disease, atherosclerotic disease, and perioperative AF. 43 , 44 A study conducted by Wang et al 21 indicated that patients who developed new-onset AF had an increased risk of postoperative stroke (OR, 1.53; 95% CI, 1.08-2.18; P = .017) and higher mortality (HR, 1.49; 95% CI, 1.22-1.81; P < .001) compared with patients without AF after cardiac surgery. 21 The key question is: if we were able to reduce the incidence of POAF through DEX use, would we then lower the incidence of postoperative stroke?…”

Stroke after coronary artery bypass surgery: Can we predict full neurological recovery?

“…Postoperative stroke is one of the most feared complications after cardiac surgery and is associated with increased mortality, prolonged hospital stay, and higher total hospitalization costs 1–3 . Age (>60 years), dialysis dependency, chronic lung disease, atrial fibrillation, and vessel disease represents the most common preoperative risk factors for stroke 3 .…”

“…Postoperative stroke is one of the most feared complications after cardiac surgery and is associated with increased mortality, prolonged hospital stay, and higher total hospitalization costs 1–3 . Age (>60 years), dialysis dependency, chronic lung disease, atrial fibrillation, and vessel disease represents the most common preoperative risk factors for stroke 3 . In addition, plenty of intraoperative risk factors may be associated with a higher risk of postoperative stroke: atherosclerosis or calcification of the aorta, aortic manipulation during coronary bypass surgery, and conventional on‐pump coronary artery bypass grafting (CABG), and prolonged time on cardiopulmonary bypass 1,4 .…”

“…It is important to state that VRSs don't identify a priori patients at neurological risk but rather help identify the likelihood of symptoms “remission.” When exploring the association between preoperative characteristics and stroke reconvalescence, normal preoperative ejection fraction (EF), arteriosclerotic degeneration of carotid arteries, and reduced glomerular filtration rate (GFR) were found to have a relationship with the lack of recovery from postoperative stroke. Several other studies have demonstrated that critical carotid stenosis at the moment of CABG and reduced GFR or dialysis are associated with a higher risk of stroke 3,7 . On the other hand, some authors have hypothesized that preserved EF may increase the risk of cardioembolic/gas embolism during heart surgery 7 …”