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Cerebral embolism in off-pump coronary artery bypass grafting
Ikuo Fukuda1, Hiroko Nakata, Hiroaki Sakamoto
1Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, Japan. ikuofuku@cc.hirosaki-u.ac.jp
Insights
Coronary artery bypass grafting may lead to stroke due to atheroembolism. Surgeons must consider this risk, especially in patients with prior cerebral infarction, to prevent atheroembolic stroke.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- A 64-year-old female patient with a history of cerebral infarction due to chronic middle cerebral artery occlusion presented with acute myocardial infarction.
- The patient underwent double, off-pump coronary artery bypass grafting for her cardiac condition.
Observation:
- Despite successful coronary artery bypass grafting, the patient experienced a stroke.
- The stroke was attributed to atheroembolism originating from the ascending aorta.
Findings:
- Coronary artery bypass grafting, even when performed off-pump, did not prevent stroke in this patient.
- Atheroembolism from the ascending aorta was identified as the cause of the postoperative stroke.
Implications:
- The risk of atheroembolism and subsequent stroke should be a critical consideration during the preoperative planning of coronary artery bypass grafting.
- Enhanced vigilance and potential preventative strategies are warranted for patients with pre-existing cerebrovascular disease undergoing aortic procedures.
Abstract:
A 64-year-old woman with a history of cerebral infarction from chronic occlusion of the middle cerebral artery presented with acute myocardial infarction. Double, off-pump coronary artery bypass grafting could not prevent stroke caused by atheroembolism from the ascending aorta. The risk of stroke from atheroembolism should be taken into consideration when planning coronary artery bypass grafting.