Consequence of Ischemic Stroke after Coronary Surgery with Cardiopulmonary Bypass According to Stroke Subtypes

Abstract

IntroductionThe aim of this study was to determine the outcomes of patients developing ischemic stroke after coronary artery bypass grafting (CABG).MethodsFrom March 2012 to January 2017, 5380 consecutive patients undergoing elective coronary surgery were analyzed. Ninety-five patients who developed ischemic strokes after on-pump coronary surgery were included in the study, retrospectively. The cohort was divided into four subgroups [total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI), and lacunar infarction (LACI)] according to the Oxfordshire Community Stroke Project (OCSP) classification. The primary endpoints were in-hospital mortality, total mortality, and survival analysis over an average of 30 months of follow-up. The secondary endpoints were the extent of disability and dependency according to modified Rankin Scale (mRS).ResultsThe incidence of stroke was 1.76% (n=95). The median age was 62.03±10.06 years and 68 (71.6%) patients were male. The groups were as follows: TACI (n=17, 17.9%), PACI (n=47, 49.5%), POCI (n=20, 21.1%), and LACI (n=11, 11.6%). Twenty-eight (29.5%) patients died in hospital and 34 (35.8%) deaths occurred. The overall mortality rate of the TACI group was significantly higher than that of the LACI group (64.7% vs. 27.3%, P=0.041). The mean mRS score of the TACI group was significantly higher than that of the other groups (P=0.003).ConclusionPatients in the TACI group had higher in-hospital and cumulative mortality rates and higher mRS scores. We believe that use of the OCSP classification and the mRS may render it possible to predict the outcomes of stroke after coronary surgery.

The relationship between neurocognitive decline and the heart‐lung machine

“…On‐pump surgeries may involve prolonged periods of hypoperfusion, further increasing patients’ risk of cerebral ischemia 1 . Such microembolic and hypoperfusive events contribute to the increased risk of stroke following procedures that use CPB 5‐12 . Of note, many studies reported that off‐pump cardiac surgeries or shorter durations of time on CPB decrease stroke risk.…”

“…1 Such microembolic and hypoperfusive events contribute to the increased risk of stroke following procedures that use CPB. [5][6][7][8][9][10][11][12] Of note, many studies reported that off-pump cardiac surgeries or shorter durations of time on CPB decrease stroke risk.…”

Our Early Results of Isolated Coronary Artery Bypass Grafting: A Case Series of The First 100 Patients In a Newly Established Heart Center

“…Furthermore, neurological complications of ischemic or hemorrhagic origin due to cerebral hypoperfusion during CPB, underlying carotid artery stenosis, air embolism, and bleeding account for 1.7% of cases with significant morbidity and mortality 12 . Therefore, it is recommended that patients aged above 70 years or those with the left main coronary artery involvement should be evaluated through Doppler imaging of the carotid artery 4 .…”

Análise do perfil dos subtipos clínicos de Doenças Cerebrovasculares Isquêmicas em pacientes admitidos em Unidade Ambulatorial em Salvador – Brasil

“…Os subtipos PACI e TACI foram os mais frequentes observados no nosso estudo. A maior frequência do subtipo PACI, é semelhante àquela observada em outros estudos nos quais também foram utilizados os critérios da escala de Bamford e que tiveram um tamanho amostral semelhante ao nosso (ALDAG M, et al, 2018;YANG Y, et al, 2016;MEAD GE, et al, 2000).…”