Related Experiment Videos
Characteristics of cerebrovascular accidents after coronary artery bypass grafting
G B Blossom1, R Fietsam, J S Bassett
1Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan 48073.
Insights
Cerebrovascular accidents (CVAs) occurred in 1.3% of patients after coronary artery bypass grafting. Embolic events and cerebral hypoperfusion were common causes, leading to significant mortality and morbidity.
Area of Science:
- Neurosurgery
- Cardiology
- Neurology
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Cerebrovascular accidents (CVAs) are a known complication following cardiac surgery.
- Understanding the incidence and causes of CVA after CABG is crucial for patient outcomes.
Purpose of the Study:
- To determine the incidence, etiology, and outcome of cerebrovascular accidents (CVAs) following coronary artery bypass grafting (CABG).
Main Methods:
- Retrospective review of medical records for patients who underwent CABG between January 1, 1987, and December 31, 1990.
- Identification of patients with CVA confirmed by head computed tomography (CT) post-neurologic findings.
- Analysis of timing, presumed etiology (embolic vs. hypoperfusion), preoperative risk factors, and patient outcomes.
Main Results:
- An overall incidence of CVA was 1.3% (46 out of 3,428 patients).
- Embolic events (54%) and cerebral hypoperfusion (46%) were the primary causes of CVA.
- Mortality following CVA was 35%; 70% of survivors showed improvement, with 60% discharged home.
Conclusions:
- CVA after CABG is an uncommon but serious complication with high morbidity and mortality.
- Identifying high-risk patients for aggressive preoperative evaluation and intraoperative monitoring may be beneficial.
- Further understanding of CVA etiology post-CABG is needed to develop preventative strategies.
Abstract:
The records of all patients who had a cerebrovascular accident (CVA) following coronary artery bypass surgery were reviewed to determine the incidence, etiology, and outcome following such an event. Between January 1, 1987, and December 31, 1990, 3,428 patients underwent bypass grafting and 46 had a CVA, documented by head computed tomography (CT) after neurologic findings were appreciated, for an incidence of 1.3 per cent. In 16 patients, a neurologic deficit was documented less than 12 hours after surgery and was presumed to have been an intraoperative event. The remaining 30 patients became symptomatic between postoperative days 2 and 7. Twenty-five patients (54%) exhibited neurologic and CT findings suggestive of an embolic event, while the remaining 21 patients appeared to have sustained an infarct as a result of cerebral hypoperfusion. Nine patients with CVA had a carotid bruit documented in the preoperative period, and seven of these suffered their ischemic event in the ipsilateral distribution. Five patients had a documented CVA previously, and four were shown to have extended areas of previous infarction. The mortality following CVA was 35 per cent. Of the survivors, 70 per cent had some improvement in symptoms at the time of discharge; 60 per cent of survivors were discharged to their homes and the remainder to extended care facilities. Although CVA following coronary bypass grafting is an uncommon event, some patients at increased risk may benefit from more aggressive preoperative noninvasive evaluation and intraoperative monitoring. A better understanding of the etiology of postoperative stroke may help to prevent its high morbidity and mortality, which has been demonstrated.