Neurologic Complications following Coronary Artery Bypass. The Role of Atherosclerotic Emboli

Abstract

Neurologic complications continue to plague aortocoronary bypass operations. All patients undergoing isolated coronary artery bypass procedures over a four-year period at the Upstate Medical Center were reviewed. Eight of 893 patients sustained a cerebrovascular accident following operation (0.9%). In 5 patients, the etiology was felt to be calcific and atherosclerotic debris from the ascending aorta. Air embolism occurred in one patient, and the etiology was unknown in 2 patients. Various methods to deal with the diffusely atherosclerotic aorta are discussed.

Strategy for reduction of stroke incidence in coronary bypass patients with cerebral lesions

“…[1][2][3][4][5][6] This decreased to between 0.63% and 2.0% using management of the atherosclerotic ascending aorta,9-" and to 1.6% using combined carotid and coronary re-vascularization.' 7 In our series, we found that this could be improved to 0.4% using the addition of pulsatile perfusion in high-risk patients.…”

Toward stroke‐free coronary surgery: The role of the anaortic off‐pump bypass technique

“…The role of aortic atherosclerosis and the “porcelain aorta” 20 (Figure 2) in the pathogenesis of neurologic injury after CABG has been postulated for almost four decades 21‐24 . Multiple cadaveric studies have documented a high embolic burden to the brain during CPB and aortic manipulation in the presence of ascending aortic atherosclerosis 25,26 .…”

Diretrizes da cirúrgia de revascularização miocárdica valvopatias e doenças da aorta

“…No ato operatório, a palpação da aorta ascendente pode demonstrar placas de aterosclerose nos mais diferentes graus, mas não é possível identificar a espessura da aorta [99][100][101][102][103] . Técnicas para minimizar as complicações: 1) canulação arterial -pode-se optar pelo arco aórtico na sua porção inferior ou lateral e ou a artéria femoral; 2) aorta (no touch) -é possível utilizar a fibrilação ventricular e dar preferência a enxertos arteriais (dupla mamária e enxertos em "Y").…”