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Strokes after cardiac surgery: mostly right hemispheric ischemic with mild residual damage

I Korn-Lubetzki1, A Oren, E Asher

  • 1Dept. of Neurology, Shaare Zedek Medical Center, 3235, Jerusalem, 91031, Israel. ikl@md.huji.ac.il

Journal of Neurology
|November 9, 2007
PubMed

Insights

Cardiac surgery patients experiencing stroke or transient ischemic attack (TIA) predominantly suffer right-hemispheric, ischemic events. Most patients achieve functional independence, suggesting a procedure-related embolic mechanism.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Surgery

Background:

  • Cardiac surgery is increasingly performed on high-risk patients with pre-existing cerebrovascular disease.
  • Acute stroke and transient ischemic attack (TIA) are potential complications following cardiac procedures.

Purpose of the Study:

  • To investigate the clinical findings and medium-term outcomes of patients who experience acute stroke or TIA after cardiac surgery.
  • To identify risk factors, stroke characteristics, and neurological deficits in this patient population.

Main Methods:

  • Prospective observation of consecutive patients undergoing cardiac surgery over a 19-month period.
  • Detailed evaluation of risk factors, stroke type, localization, initial deficit, and follow-up outcomes using standard assessment scores.
  • Follow-up duration ranged from 3 to 21 months.

Main Results:

  • Eighteen patients developed stroke and 2 experienced TIAs among 406 operated patients.
  • Most strokes were right-hemispheric and ischemic, occurring shortly after valve surgery.
  • Vertebrobasilar strokes appeared later and were linked to cardiac arrhythmias; two such cases resulted in in-hospital mortality.
  • Stroke/TIA patients had worse cardiac functional scores and longer cardiopulmonary bypass times, but not higher preoperative risk.

Conclusions:

  • Strokes following cardiac surgery are predominantly right-hemispheric and ischemic.
  • The overall outcome for hemispheric stroke patients is relatively favorable, with most achieving functional independence.
  • A procedure-related embolic injury to the right hemisphere is proposed as a likely mechanism.
Abstract

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