Risk factors for perioperative ischemic stroke in cardiac surgery

Abstract

ObjectiveThe purpose of this study was to evaluate the risk factors for ischemic stroke in patients undergoing cardiac surgery.MethodsFrom January 2010 to December 2012, 519 consecutive patients undergoing cardiac surgery were analyzed prospectively. The sample was divided into two groups: patients with stroke per and postoperative were allocated in Group GS (n=22) and the other patients in the group CCONTROL (n=497). The following variables were compared between the groups: gender, age, carotid stenosis ≥ 70%, diabetes on insulin, chronic obstructive pulmonary disease, peripheral arteriopathy, unstable angina, kidney function, left ventricular function, acute myocardial infarction, pulmonary arterial hypertension, use of cardiopulmonary bypass. Ischemic stroke was defined as symptoms lasting over 24 hours associated with changes in brain computed tomography scan. The variables were compared using Fisher’s exact test, Chi square, Student’s t-test and logistic regression.ResultsStroke occurred in 4.2% of patients and the risk factors statistically significant were: carotid stenosis of 70% or more (P=0.03; OR 5.07; IC 95%: 1.35 to 19.02), diabetes on insulin (P=0.04; OR 2.61; IC 95%: 1.10 to 6.21) and peripheral arteriopathy (P=0.03; OR 2.61; 95% CI: 1.08 to 6.28).ConclusionRisk factors for ischemic stroke were carotid stenosis of 70% or more, diabetes on insulin and peripheral arteriopathy.

Protective effect of high n-3/n-6 PUFA ratio on acute hypoxic-ischemic brain damage in mfat-1 transgenic mice and possible inflammation-related targets identified by transcriptome analysis

“…One of the signi cant risk factors that patients undergoing major cardiothoracic surgery is ischemic stroke [47]. In order to prevent subsequent occurrence of central nervous system diseases, related events must be either reduced in severity or prevented completely.…”

Newly Developed Major Neurological Injury After Open Heart Surgery

“…Ameliyat odasında elektrokardiyografi (EKG), invaziv arteriyel kan basıncı, periferik oksijen satürasyonu, soluk sonu CO 2 , santral venöz basınç (internal juguler venden), nazofarengeal ve rektal ısılar monitörize edilir. Anestezi indüksiyonunda midazolam (Roche Ltd Basel, Switzerland) 0.1 mg/kg -1 , fentanil (Janssen-Cilag, Beerse-Belgium) 5-10 mcg/kg -1 , rokuronyum 0.5 mg/kg - daha düşük oranlar göze çarpmakta iken, bütün açık kalp cerrahisi olgularının dâhil edildiği çalışmalarda %5.4'e varan daha yüksek sıklıklar ortaya sunulmaktadır (3,4,(7)(8)(9)(10)(11) . Gözlemlerimiz bütün kalp cerrahisi olgularını içermektedir.…”

“…İntraoperatif risk faktörlerine bakıldığında cerrahi tipine göre aort cerrahisi ve çoklu prosedür olgularında risk daha yüksek sunulmaktadır. Aortik aterom üzerine kros klempleme, KPB sırasında mikroembolizasyon, hipoperfüzyon, ısı ve hematokrit değişkenleri de intraoperatif risk faktörleri arasında değerlendirilmektedir [10,11] . Birçok yerde inme önlemi olarak rutin uygulanan epiaortik ultrason dijital palpasyonla belirlenemeyen aterom plaklarını saptamakta ve böylece aort üzerindeki manipülasyonlar kontrollü şekilde yapılmaktadır [13] .…”

Distribution of perioperative stroke in cardiac surgery

“…For that reason thromboembolic stroke after cardiac surgery that was assumed to be of cardiac origin in all cases was studied. Ischaemic stroke after cardiac surgery has an incidence of about 2% [11,12]. It was hypothesized that thromboembolic stroke after cardiac surgery was more often localized in the posterior cerebral circulation compared to patients hospitalized with ischaemic stroke without prior cardiac surgery.…”