Stroke after CABG

Stroke after CABG

Factors predicting stroke after CABG are the following:

  1. Presence of intracerebral and extracerebral atherosclerotic disease
  2. Demonstration of previous stroke by imaging
  3. Atheromatous disease of the aorta

It may be noted that aortic plaques have a high chance of embolization while cannulating the aorta for cardiopulmonary bypass. Some cardiothoracic surgeons take a plain computed tomogram of the chest to assess calcification of the aorta prior to CABG. Total arterial revascularization avoiding taking grafts from the aorta may be a good strategy in suitable cases to avoid the risk of atheroembolism from the aorta.

Avoiding cardiopulmonary bypass with off pump CABG may have an edge over conventional on pump CABG in this situation. Previous history of stroke or transient ischemic attacks within the previous six months is an important risk factor for perioperative stroke. Though the chance for stroke is lesser with percutaneous coronary intervention at 30 days and one year, the rates of stroke rather catch up by 5 years, indicating a basic predisposition which manifests in due time.

Other than cerebral embolisation of atheromatous material from the ascending aorta during surgical manipulation, hypoperfusion during surgery may also be an important factor. This is more likely in those with pre-existing clinically silent cerebral atherosclerosis in which an event is precipitated by hypoperfusion [1].

Reference

  1. Palmerini T, Savini C, Di Eusanio M. Risks of Stroke After Coronary Artery Bypass Graft – Recent Insights and Perspectives. Interv Cardiol. 2014 Apr;9(2):77-83.