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Mechanism of stroke complicating cardiopulmonary bypass surgery
J M Rankin1, P L Silbert, O P Yadava
1Cardiology Department, Royal Perth Hospital, WA.
Insights
Stroke following cardiopulmonary bypass (CPB) occurs in 1.6% of cases, predominantly as ischemic events. Prevention strategies should focus on cerebral embolism and borderzone infarction.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Stroke is a significant complication of cardiopulmonary bypass (CPB) surgery, affecting 1-5% of patients.
- Understanding the causes of CPB-related stroke is crucial for developing effective prevention strategies.
Purpose of the Study:
- To investigate the incidence, pathology, and etiology of stroke in patients undergoing CPB.
- To identify the primary mechanisms contributing to stroke after CPB.
Main Methods:
- A prospective study was conducted over 18 months.
- Clinical, operative, and cranial CT scan data were reviewed for all stroke cases complicating CPB.
- Incidence, stroke type, and potential causes were analyzed.
Main Results:
- Twenty-one strokes (1.6%) occurred in 1336 CPB procedures.
- All strokes were ischemic; 12 (57%) were attributed to embolism and 9 (43%) to hypoperfusion (borderzone infarction).
- No hemorrhagic strokes were observed.
Conclusions:
- Stroke is a notable complication of CPB, with an incidence of 1.6% in this series.
- Ischemic stroke, caused by embolism or borderzone infarction, is the predominant type.
- Future stroke prevention efforts in CPB patients should target these two mechanisms.
Background:
Stroke is a devastating complication of cardiopulmonary bypass (CPB) surgery which occurs in 1 to 5% of cases. Strategies to reduce its incidence require a knowledge of the underlying pathology and aetiology.
Aims:
To determine the incidence, pathology and aetiology of stroke complicating CPB.
Methods:
Prospective review of clinical, operative and cranial CT scan findings in all cases of stroke complicating CPB procedures in our institution over an 18 month period.
Results:
Twenty-one (1.6%, 95% CI 0.9-2.3%) cases of stroke were identified from 1336 CPB procedures. Cranial CT scan, performed in all but one patient, was normal in three patients or consistent with ischaemic stroke in 17 patients. There were no cases of haemorrhagic infarction or intracerebral haemorrhage. It was difficult to differentiate embolic and borderzone infarcts in two cases. After considering the clinical, operative and CT scan features together, 12 (57%, 95% CI 36-78%) of the cases were felt to be embolic in origin and nine (43%, 95% CI 22-64%) due to hypoperfusion in a borderzone.
Conclusions:
This study demonstrates that stroke remains an important complication of CPB procedures with an incidence in our series of 1.6%. The pathologic type of stroke is predominantly ischaemic in nature due to either cerebral embolism or borderzone infarction. Strategies for stroke prevention in patients undergoing CPB should be targeted primarily at these two mechanisms.