Adverse Neurologic Outcome Following Cardiac Surgery

Risk of Ischemic Stroke in Patients With Symptomatic Vertebrobasilar Stenosis Undergoing Surgical Procedures

“…In patients 2 and 3, a cardiac source of embolism was clearly possible, although patient 2 had a syndrome typically described in association with basilar artery stenosis or occlusion. 21 Because intracardiac procedures have been associated with stroke rates as high as 5.9%, 7 this factor may have skewed our results. Other cardiac series have suggested that embolization rather than hypoperfusion is the predominant stroke mechanism, 22 further minimizing the role of large-artery occlusive disease in this setting.…”

“…17 The stroke risk associated with coronary bypass grafting (CABG) ranges from 2.2% 5 to 5.2% 6 and is highest when concurrent valve surgery or other intracardiac procedures are performed. 7 Ultrasound 4,5,12,14 and angiographic 15 studies of the carotid circulation in patients undergoing cardiac procedures have shown variable risk rates for perioperative stroke. Some early studies 18 have not shown severe carotid stenosis to be a risk for stroke after cardiac surgery, whereas others have confirmed an association with increasing degrees of stenosis.…”

Cerebral complications in conventional coronary bypass graft surgery

“…9 Etiology: Intra-operative embolization remained a major cause of post-CABG stroke. [23][24][25][26][27][28][29][30][31][32][33][34][35] Two-third of strokes resulted from numerous small atheroemboli that predominantly affected the occipital lobe and the area lying between the supply of middle cerebral and posterior cerebral arteries. 8 In one-third of cases, infarct lesion was single and involved the area supplied by the middle cerebral, vertebral and basilar arteries.…”

“…8 In a multi-center study involving 2,264 post-CABG patients, Wolman, et al, found that neurological complications increased by almost twice in patients who underwent CABG combined with other intracardiac surgery. 34…”