Related Experiment Video
Updated: Aug 11, 2026
Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Impaired baseline regional cerebral perfusion in patients referred for coronary artery bypass
Robert Moraca1, Eugene Lin, James H Holmes
1Department of General Surgery, Virginia Mason Medical Center, Seattle, Wash 98107, USA. robert.moraca@vmmc.org
Insights
Most patients undergoing coronary artery bypass grafting have impaired cerebral perfusion, increasing stroke risk. This study highlights the need to address regional cerebral blood flow in cardiac surgery patients.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cognitive dysfunction and stroke are significant risks following cardiac surgery.
- Patients undergoing coronary artery bypass grafting (CABG) often have diminished cerebral reserve.
- Understanding regional cerebral perfusion is crucial for managing these risks.
Purpose of the Study:
- To investigate regional cerebral perfusion in patients with coronary artery disease (CAD) scheduled for CABG.
- To identify factors associated with impaired cerebral blood flow in this patient cohort.
Main Methods:
- Prospective study of 82 CAD patients undergoing CABG.
- Preoperative regional cerebral perfusion assessed using single photon emission computed tomography (SPECT) in 12 brain regions.
- Abnormal perfusion defined as >2 standard deviations below age-matched controls.
Main Results:
- 75% of patients showed abnormal regional cerebral perfusion on SPECT scans.
- Impaired perfusion was linked to older age, tobacco use, and diabetes.
- Postoperative stroke occurred in 5% of patients, exclusively those with abnormal perfusion.
Conclusions:
- A high prevalence of impaired regional cerebral perfusion exists in patients with CAD undergoing CABG.
- This perfusion deficit may predispose patients to cerebral complications after surgery.
- Further research into optimizing cerebral blood flow during CABG is warranted.
Background:
Cognitive dysfunction and cerebral vascular accidents remain some of the most devastating problems related to cardiac surgery. Despite the major advances in perioperative care and operative technique in coronary artery bypass, this cohort of patients appears to have poor cerebral physiologic reserve. The aim of this study was to describe regional cerebral perfusion of patients with coronary artery disease referred for coronary artery bypass grafting.
Methods:
Eighty-two consecutive patients with coronary artery disease referred for coronary artery bypass grafting were enrolled after providing informed consent in an institutional review board-approved study. Patients with prior cerebral vascular accident, transient ischemic attacks, head trauma, or other neurologic afflictions were excluded from the study. We prospectively measured preoperative regional cerebral perfusion using single photon emission computed tomography (SPECT) imaging of 12 regions. Patients were determined to have an abnormal SPECT if regional cerebral perfusion was less than 2 standard deviations below the mean of age-matched controls.
Results:
The mean age was 67.5 (range, 34-89) years. The study group comprised 22% women and 78% men with known risk factors for atherosclerosis: current tobacco use (30%), hypertension (69%), and diabetes (27%). Seventy-five percent of the SPECT scans demonstrated abnormal regional cerebral perfusions, which were associated with older age (P < .008), current tobacco use (P < .005), and diabetes mellitus (P < .005). The incidence of postoperative cerebral vascular accident was 5% and only occurred in patients with abnormal regional cerebral perfusion.
Conclusion:
Seventy-five percent of patients undergoing coronary bypass grafting have a significant impairment in regional cerebral perfusion compared with published age-matched controls, which may contribute to their proclivity for cerebral complications.
