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Distribution of perioperative stroke in cardiac surgery
R Pierik1, M Uyttenboogaart2, M E Erasmus3
1Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Insights
Cardiac surgery patients experience posterior circulation strokes twice as often as the general population. This suggests a higher likelihood of cardiac origin, potentially warranting further cardiac investigations for these stroke patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Recent literature indicates a higher prevalence of cardiac origins in ischemic stroke than previously recognized.
- Identifying patients who require further cardiac investigation for stroke, especially when obvious cardiac pathology is absent, remains challenging.
Purpose of the Study:
- To investigate the frequency and location of strokes in patients following cardiac surgery.
- To compare the characteristics of strokes in cardiac surgery patients with those in the general ischemic stroke population.
Main Methods:
- A retrospective observational study analyzed 7454 intensive care unit patients who underwent cardiac surgery (2006-2015) and had postoperative brain imaging.
- Stroke occurrence, subtype, and vascular territory were assessed, assuming perioperative thromboembolic strokes were cardiac in origin.
- A control group of ischemic stroke patients without prior cardiac surgery was used for comparison.
Main Results:
- Thromboembolic stroke occurred in 135 cardiac surgery patients; 41% involved the posterior cerebral circulation.
- In the control group, 20% of strokes were located in the posterior cerebral circulation.
- The relative risk of posterior circulation stroke after cardiac surgery was 2.09 (95% CI 1.60-2.72) compared to the control group.
Conclusions:
- Thromboembolic stroke post-cardiac surgery disproportionately affects the posterior cerebral circulation (twice as often as in general ischemic stroke).
- These findings suggest an increased likelihood of cardiac origin in patients with posterior circulation ischemic strokes.
- Further cardiac investigations, such as long-term heart rhythm monitoring or echocardiography, may be beneficial for patients with posterior circulation strokes.
Background And Purpose:
The recent literature suggests that a cardiac origin in ischaemic stroke is more frequent than previously assumed. However, it is not always clear which patients benefit from additional cardiac investigations if obvious cardiac pathology is absent.
Methods:
A single-center retrospective observational study was performed with 7454 consecutive patients admitted to the intensive care unit after cardiac surgery in the period 2006-2015 and who had postoperative brain imaging. Cerebral imaging was studied for the occurrence of stroke including subtype and involved vascular territory. It was assumed that all perioperative thromboembolic strokes are of cardiac origin. Data obtained from a hospital cohort of consecutive patients who received a diagnosis of ischaemic stroke were used for comparison.
Results:
Thromboembolic stroke occurred in 135 cardiac surgery patients in 56 (41%) of whom the posterior cerebral circulation was involved. In the control group, 100 out of 503 strokes (20%) were located in the posterior cerebral circulation. The relative risk for a posterior location for stroke after cardiac surgery compared to patients with ischaemic stroke without prior cardiac surgery was 2.09; 95% confidence interval 1.60-2.72.
Conclusions:
Thromboembolic stroke after cardiac surgery occurs twice as often in the posterior cerebral circulation compared to ischaemic strokes in the general population. If confirmed in general stroke cohorts, the consequence of this finding may be that in patients with an ischaemic stroke that involves the posterior cerebral circulation the chance of a cardiac origin is increased and therefore might trigger additional cardiac investigations such as long-term heart rhythm monitoring or echocardiography.
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