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Updated: Aug 19, 2026
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Methods of detecting potential causes of vascular cognitive impairment after coronary artery bypass grafting
David Russell1, Nathan Bornstein
1Department of Neurology, The National Hospital, University of Oslo, Sognsvannsveien 20, N-0027 Oslo, Norway. david.russell@rikshospitalet.no
Insights
Coronary artery bypass grafting (CABG) surgery can lead to frequent neuropsychological deficits. Transcranial Doppler monitoring helps detect brain changes and potential issues during CABG procedures.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Neurology
Background:
- Coronary artery bypass grafting (CABG) is a prevalent surgical procedure globally.
- Neuropsychological deficits are common post-CABG, affecting a significant percentage of patients in the early and long-term postoperative periods.
- Existing research indicates potential cerebral complications following CABG.
Purpose of the Study:
- To evaluate the utility of Transcranial Doppler (TCD) monitoring during CABG surgery.
- To investigate the occurrence of microemboli and changes in cerebral hemodynamics during the procedure.
- To correlate intraoperative events with postoperative neurological outcomes.
Main Methods:
- Utilized Transcranial Doppler (TCD) for continuous brain monitoring during CABG.
- Monitored for the presence of solid and gaseous microemboli, particularly during aortic manipulation.
- Assessed cerebral hemodynamic parameters, including perfusion pressure, to detect significant changes.
- Correlated TCD findings with postoperative neurological assessments and Magnetic Resonance Imaging (MRI) results.
Main Results:
- Transcranial Doppler (TCD) monitoring effectively identified frequent solid and gaseous microemboli during CABG, especially during aortic clamping and declamping.
- TCD detected alterations in cerebral hemodynamics, signaling potential perfusion deficits.
- Magnetic resonance imaging (MRI) studies revealed increased brain water content and new postoperative cerebral lesions in patients undergoing "on-pump" CABG.
Conclusions:
- Transcranial Doppler (TCD) is a valuable tool for real-time brain monitoring during CABG, enabling early detection of embolic events and hemodynamic instability.
- Intraoperative microemboli and altered cerebral perfusion during CABG are associated with postoperative neurological deficits and cerebral lesions.
- Continuous TCD monitoring can alert surgical teams to potential brain injury, facilitating timely interventions to improve patient outcomes.
Abstract:
Coronary artery bypass grafting (CABG) is the most common major surgical procedure performed worldwide. Neuropsychological deficits are frequent following CABG occurring in up to 80% in the early postoperative period, 20-50% at 6 weeks and 10-30% of patients at 6 months. Transcranial Doppler monitoring is well suited for monitoring the brain during surgery. It has been shown that both solid and gaseous microemboli are frequent during, surgery especially during clamping and declamping of the aorta. This method can also monitor cerebral hemodynamics during surgery and alert the surgical team when a fall in perfusion pressure occurs. Magnetic resonance imaging (MRI) studies have found evidence which suggests increased water content in the brain following "on-pump" CABG. New postoperative cerebral lesions have also been found in many patients using diffusion-weighted MRI.
