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Published on: May 9, 2013

Importance of cerebral artery risk evaluation before off-pump coronary artery bypass grafting to avoid perioperative

Kiyoshi Doi1, Hitoshi Yaku

  • 1Department of Cardiovascular Surgery, Koto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi, Hirokoji, Kamikyo-ku, Kyoto 602-8566, Japan. kdoi@koto.kpu-m.ac.jp

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 20, 2010
PubMed

Insights

Patients with cerebrovascular disease undergoing off-pump coronary artery bypass grafting (CABG) did not experience intra-operative stroke. However, high-risk patients had a higher incidence of delayed stroke within 30 days post-CABG.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Surgery

Background:

  • Cerebrovascular atherosclerotic disease is a known risk factor for stroke following coronary artery bypass grafting (CABG).
  • Off-pump CABG aims to reduce perioperative complications compared to conventional CABG.
  • The specific risk of stroke in patients with cerebrovascular disease undergoing off-pump CABG requires further evaluation.

Purpose of the Study:

  • To assess the incidence of stroke in patients with significant cerebrovascular disease undergoing off-pump CABG.
  • To compare stroke incidence between high-risk and low-risk groups for perioperative stroke.
  • To identify the timing and potential causes of stroke in this patient population.

Main Methods:

  • A retrospective study of 611 patients who underwent off-pump CABG.
  • Patients were stratified into high-risk (n=196) and low-risk (n=415) groups based on preoperative cerebrovascular assessments (MRI/MRA, Doppler sonography).
  • Comparison of stroke incidence between the two groups.

Main Results:

  • No intra-operative strokes were observed in any patient group.
  • Seven patients (3.6%) in the high-risk group and one patient (0.2%) in the low-risk group experienced delayed stroke (postoperative day 1-18).
  • Thromboembolism was the primary cause of delayed stroke, with a significantly higher incidence in the high-risk group (p=0.011).

Conclusions:

  • Off-pump CABG appears safe regarding intra-operative stroke in patients with significant cerebrovascular disease.
  • Patients with cerebrovascular disease undergoing off-pump CABG are at risk for delayed stroke, predominantly within 30 days post-surgery.
  • Preoperative identification of high-risk patients is crucial for monitoring and potentially mitigating delayed stroke events after off-pump CABG.
Abstract

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