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Coronary artery bypass grafting-associated ischemic stroke. A clinical and neuroradiological study
1Department of Neurology (Critical Care Neurology), Mayo Clinic, Rochester, MN 55905, USA.
Insights
Ischemic stroke after coronary artery bypass grafting (CABG) is often embolic. This study analyzed 25 patients, finding single-territory infarcts common in late-onset strokes, suggesting an embolic origin for post-CABG strokes.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Coronary artery bypass grafting (CABG) is associated with ischemic stroke, but its perioperative course and radiological features remain unclear.
- Understanding the characteristics of these strokes is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the clinical and computed tomography (CT) features of ischemic stroke following CABG.
- To investigate the potential causes and patterns of stroke in this patient population.
Main Methods:
- Retrospective analysis of 25 patients who experienced ischemic stroke after CABG.
- Clinical data review, including operative hypotension and new-onset atrial fibrillation.
- Computed tomography (CT) scans for infarct topography.
- Duplex sonography of carotid arteries and oculoplethysmography (OPG) in select patients.
- Postoperative echocardiography (including transesophageal) to assess for cardiac sources of embolism.
Main Results:
- Four patients had early stroke, all with operative hypotension; three had multiple infarcts.
- Twenty-one patients had late-onset stroke, with 19 showing single-territory infarcts (MCA, PCA, ACA territories).
- No watershed infarcts were observed. New-onset atrial fibrillation and single-territory infarcts were more frequent after an asymptomatic interval.
- Carotid stenosis was rare (1/13 patients). Left ventricular thrombus was found in 2/21 patients undergoing echocardiography.
Conclusions:
- Findings suggest that post-CABG stroke is predominantly embolic in origin.
- The pattern of infarcts, particularly single-territory involvement in late-onset strokes, supports an embolic mechanism.
- Further research into embolic sources and prevention strategies is warranted.
Abstract:
Ischemic stroke occurring after coronary artery bypass grafting (CABG) has been attributed to various factors. Little is known about the perioperative course and radiological topography of CABG-associated strokes. In this study the clinical and computed tomography features of 25 patients with ischemic stroke following coronary artery bypass grafting were evaluated. Four patients awakened with focal signs, and 21 developed an ischemic stroke 1 to 22 days after surgery. All 4 patients with early stroke had prolonged episodes of operative hypotension. Three of these patients had multiple subcortical and cortical infarcts. Of the 21 patients with late-onset ischemic stroke, 19 had single-territory infarcts (middle cerebral artery territory, N = 12; posterior cerebral artery territory, N = 4; anterior cerebral artery territory, N = 3). Two patients had multiple territory infarcts in the anterior and posterior circulation. No watershed infarcts were found in any of the 25 patients. New-onset atrial fibrillation and location of ischemic stroke in a single vascular territory were more common in patients who had an ischemic stroke after an asymptomatic interval. Duplex sonographic findings of the carotid arteries and oculoplethysmography (OPG) were available for 13 patients. Only 1 patient had an ipsilateral carotid stenosis. Of 21 patients who underwent postoperative two-dimensional echocardiography (with additional transesophageal echocardiography in 4), 2 had a left ventricular thrombus. These findings support the concept that post-CABG stroke is likely embolic.