Perioperative Stroke in Patients Undergoing CABG

1. PERIOPERATIVE STROKE
IN PATIENTS UNDERGOING
CABG
Ade Wijaya, MD – December
2017

2. OUTLINE:
 Introduction
 Etiology / risk factors
 Clinical features
 Prognosis
 Summary

3. INTRODUCTION
Stroke is one of the most devastating complications of cardiac
surgery
it can lead to a decreased quality of life, increased mortality and also
has important economic consequences.
During or after surgery
Incidence: 2-9 %; Stroke risk increased with age.
Nasreen, A., Tanveer, R., Khuwaja, A., Khan, S., Amjad, N., & Dar, M. I. (2016). PERIOPERATIVE STROKE IN PATIENTS UNDERGOING CONVENTIONAL CORONARY ARTERY BYPASS GRAFTING (CABG)-AN EXPERIENCE AT
NICVD KARACHI. Pakistan Heart Journal, 49(2).
Naylor, A. R., Mehta, Z., Rothwell, P. M., & Bell, P. R. F. (2002). Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. European journal of vascular and endovascular
surgery, 23(4), 283-294.

4. ETIOLOGY / RISK FACTORS
• Age
• Prior stroke or TIA
• Prolonged cardiopulmonary bypass
• Aortic arch disease
• Carotid artery disease
• Peripheral vascular disease
• The use of alpha adrenergic drugs
• Previous CEA
• The presence of carotid bruit
• Post-infarction angina
• Pulmonary disease
• Calcifications in proximal aorta
• Recent myocardial infarction
• Left mainstem coronary artery disease
• Redo cardiac surgery
• Diabetes
• Smoking
• Ventricular thrombus
• Hypotension
• Pre-operative hypertension
• Diuretic use
• Impaired renal function
• Cardiac failure
Naylor, A. R., Mehta, Z., Rothwell, P. M., & Bell, P. R. F. (2002). Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. European journal of vascular and endovascular
surgery, 23(4), 283-294.

5. CLINICAL FEATURES
Delirium
Transient or persistent cognitive deficits
Seizures
Anterior spinal artery infarction
Transient focal cerebral ischemia
Stroke
Nasreen, A., Tanveer, R., Khuwaja, A., Khan, S., Amjad, N., & Dar, M. I. (2016). PERIOPERATIVE STROKE IN PATIENTS UNDERGOING CONVENTIONAL CORONARY ARTERY BYPASS GRAFTING (CABG)-AN EXPERIENCE AT
NICVD KARACHI. Pakistan Heart Journal, 49(2).

6. Naylor, A. R., Mehta, Z., Rothwell, P. M., & Bell, P. R. F. (2002). Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. European journal of vascular and endovascular
surgery, 23(4), 283-294.

7. PROGNOSIS
Neurological status is clearly an important predictor for stroke after
CABG
The overall case fatality following post-CABG stroke was 23.1% - 24,8
%
The mortality of stroke is high because of delayed diagnosis and
delayed treatment.
Naylor, A. R., Mehta, Z., Rothwell, P. M., & Bell, P. R. F. (2002). Carotid artery disease and stroke during coronary artery bypass: a critical review of the literature. European journal of vascular and endovascular
surgery, 23(4), 283-294.
Nasreen, A., Tanveer, R., Khuwaja, A., Khan, S., Amjad, N., & Dar, M. I. (2016). PERIOPERATIVE STROKE IN PATIENTS UNDERGOING CONVENTIONAL CORONARY ARTERY BYPASS GRAFTING (CABG)-AN EXPERIENCE AT
NICVD KARACHI. Pakistan Heart Journal, 49(2).

8. SUMMARY
Stroke is one of the most devastating complications of cardiac surgery
it can lead to a decreased quality of life, increased mortality and also has important
economic consequences.
During or after surgery
Neurological status is clearly an important predictor for stroke after CABG
Various risk factors
High overall case fatality rate