Intracranial atherosclerosis as a risk factor for ischemic stroke during open heart surgery

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Medicine

Background:

• Embolic stroke is a significant complication following open heart surgery.
• Preoperative assessment often focuses on carotid arteries, neglecting intracranial atherosclerosis.
• Intracranial atherosclerosis is a potential, yet under-assessed, mechanism for perioperative stroke.

Purpose of the Study:

• To determine the frequency of intracranial atherosclerosis as a mechanism for perioperative ischemic stroke.
• To investigate the role of intracranial stenosis in patients experiencing stroke after open heart surgery.

Main Methods:

• A retrospective review of a prospectively maintained database of open heart surgeries performed between 2005 and 2007.
• Analysis of patients who developed periprocedural ischemic stroke.
• Radiographic imaging of the intracranial circulation to identify atherosclerosis.

Main Results:

• Out of 10,367 patients, 180 (1.74%) experienced ischemic stroke.
• Intracranial imaging was performed on 98 stroke patients, revealing intracranial vessel narrowing in 29 (30%).
• Nine patients (9.1% of stroke cases) had strokes attributed solely to intracranial stenosis.

Conclusions:

• Intracranial atherosclerosis may be an underreported cause of perioperative stroke.
• Further investigation is warranted to establish the prevalence of intracranial atherosclerosis in this patient group.
• Understanding this mechanism could improve stroke risk assessment and prevention strategies after cardiac surgery.