Neurological monitoring and off-pump surgery in a very high-risk stroke patient

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Medicine

Background:

• Coronary artery bypass grafting (CABG) is associated with a significant risk of perioperative stroke, particularly in patients with pre-existing cerebrovascular disease.
• Severe four-vessel cerebrovascular disease poses a challenge for revascularization strategies due to high stroke risk.
• Managing patients with combined severe coronary and cerebrovascular disease requires careful consideration of surgical approaches to minimize neurological complications.

Observation:

• A patient presented with symptomatic coronary artery disease and severe, non-revascularizable four-vessel cerebrovascular disease.
• The patient underwent off-pump coronary artery bypass surgery to mitigate the risks associated with aortic manipulation.
• Intraoperative electroencephalographic monitoring was employed to assess cerebral perfusion during the procedure.

Findings:

• Coronary revascularization was successfully achieved using the off-pump technique.
• The patient experienced no neurologic complications following the surgical intervention.
• The chosen surgical strategy effectively addressed the coronary disease without compromising cerebral perfusion.

Implications:

• Off-pump coronary artery bypass surgery may be a viable strategy to reduce stroke risk in patients with severe cerebrovascular disease.
• Intraoperative electroencephalographic monitoring can aid in managing cerebral perfusion during high-risk cardiac procedures.
• This approach offers a potential solution for complex cases involving combined coronary and cerebrovascular disease, warranting further investigation.