Related Experiment Videos
Risk factors for stroke in patients undergoing coronary artery bypass grafting
D A Bull1, L A Neumayer, G C Hunter
1Department of Surgery, Veterans Affairs Medical Center, Tucson, Arizona.
Insights
Stroke after coronary artery bypass grafting (CABG) is a serious risk. Ventricular thrombus was highly predictive of stroke, while carotid artery stenosis was not a significant factor in this study.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Vascular Surgery
Background:
- Stroke is a major complication following coronary artery bypass grafting (CABG).
- Identifying pre-operative risk factors for post-CABG stroke is crucial for patient management.
- Existing literature presents varied findings on risk factors for stroke after CABG.
Purpose of the Study:
- To prospectively identify risk factors for stroke in patients undergoing elective CABG.
- To evaluate the predictive value of specific clinical and imaging findings for post-CABG stroke.
- To differentiate between early and delayed stroke causes after CABG.
Main Methods:
- Prospective examination of 245 consecutive patients undergoing elective CABG over 30 months.
- Evaluation of risk factors including hypertension, diabetes, lipid profiles, smoking, atrial fibrillation, prior cerebrovascular events, carotid stenosis (>60%), ascending aorta atherosclerosis, and ventricular thrombus.
- Postoperative stroke surveillance to identify incidence and timing.
Main Results:
- The incidence of postoperative stroke was 2% (5 out of 245 patients).
- Early strokes were attributed to atheroembolism (3 patients) and severe ipsilateral carotid stenosis (1 patient).
- A delayed stroke was due to hypertensive hemorrhage (1 patient). Ventricular thrombus was a strong predictor of stroke, whereas carotid artery stenosis was not.
Conclusions:
- Ventricular thrombus is a significant predictor of stroke following CABG.
- Carotid artery stenosis (>60%) did not prove to be a predictive factor for stroke in this cohort.
- Understanding these specific risk factors can aid in refining patient selection and perioperative care to mitigate stroke risk.
Abstract:
Stroke is a significant cause of morbidity and mortality following coronary artery bypass grafting (CABG). Over a 30-month period, 245 consecutive patients undergoing elective CABG were prospectively examined to determine which risk factors might predispose to stroke following surgery. The risk factors evaluated included hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, smoking, atrial fibrillation, a history of cerebrovascular accident or transient ischemic attack, carotid artery stenosis > 60% documented by duplex scanning, severe atherosclerosis of the ascending aorta, and the presence of ventricular thrombus. Postoperative stroke occurred in five of the 245 patients (2%), four evident immediately on awakening and one on day 7 after surgery. The probable causes of the immediate strokes were atheroembolism in three patients and severe ipsilateral carotid stenosis in one. Hypertensive hemorrhage was responsible for the one case of delayed stroke. In this study, carotid artery stenosis did not presage stroke following CABG, but ventricular thrombus was highly predictive of stroke after surgery.