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Updated: Aug 26, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Chronologic distribution of stroke after minimally invasive versus conventional coronary artery bypass
Garrett K Peel1, Sotiris C Stamou, Mercedes K C Dullum
1Section of Cardiac Surgery, Washington Hospital Center, Washington, DC 20010, USA.
Insights
On-pump coronary artery bypass graft (CABG) surgery is linked to earlier stroke onset compared to off-pump CABG. This suggests different stroke development mechanisms between the two surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Clinical Outcomes
Background:
- Off-pump coronary artery bypass graft (CABG) surgery is associated with a lower stroke rate than conventional on-pump CABG.
- The temporal pattern of stroke onset following these two surgical approaches remains unclear.
Purpose of the Study:
- To compare the chronologic distribution of stroke onset after off-pump CABG versus on-pump CABG.
- To identify predictors of early stroke and the association with surgical approach.
Main Methods:
- Retrospective analysis of 10,573 patients undergoing CABG between June 1996 and August 2001.
- Utilized the Northern New England preoperative estimate of stroke risk for risk factor identification.
- Employed multivariate logistic regression to analyze stroke predictors and surgical approach impact.
Main Results:
- Stroke occurred in 2% of patients (217/10,573).
- Median stroke onset was 2 days after on-pump CABG vs. 4 days after off-pump CABG (p < 0.01).
- On-pump CABG showed a significantly higher risk of early stroke (OR 5.3, p < 0.01).
Conclusions:
- On-pump CABG is associated with an earlier onset of postoperative stroke compared to off-pump CABG.
- Findings suggest distinct pathophysiologic mechanisms for stroke in on-pump versus off-pump procedures.
- Understanding these differences may inform stroke prevention strategies.
Objectives:
We sought to investigate whether the chronologic distribution of the onset of stroke occurring after coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass (off-pump CABG) is different from the conventional on-pump approach (CABG with cardiopulmonary bypass).
Background:
Off-pump CABG has been associated with a lower stroke rate, compared with conventional on-pump CABG. However, it is unknown whether the chronologic distribution of the onset of stroke is different between the two approaches.
Methods:
We evaluated the chronologic distribution of postoperative stroke in patients undergoing CABG from June 1996 to August 2001 (n = 10,573). Preoperative risk factors for stroke were identified using the Northern New England preoperative estimate of stroke risk. Multivariate logistic regression analysis was used to determine the independent predictors of early stroke and to delineate the association between the surgical approach and the chronologic distribution of the onset of stroke.
Results:
Stroke occurred in 217 patients (2%, n = 10,573). A total of 44 (20%) and 173 (80%) of these patients had stroke after off-pump CABG and on-pump CABG, respectively. The median time for the onset of stroke was two days (range 0 to 11 days) after on-pump CABG versus four days (range 0 to 14 days) after off-pump CABG (p < 0.01). On-pump CABG was associated with a higher risk of early stroke (odds ratio 5.3, 95% confidence interval 2.6 to 10.9; p < 0.01) compared with off-pump CABG.
Conclusions:
Compared with off-pump CABG, on-pump CABG is associated with an earlier onset of postoperative stroke during the recovery phase, suggesting different mechanisms in the pathogenesis of stroke between the two surgical approaches.
