Stroke, Vol 25, 2398-2402, Copyright © 1994 by American Heart Association
D Barbut, RB Hinton, TP Szatrowski, GS Hartman, M Bruefach, P Williams-Russo, ME Charlson and JP Gold
BACKGROUND AND PURPOSE: Transcranial Doppler ultrasonography detects
embolic signals during coronary artery bypass surgery. The relationship
between embolization and specific events of bypass surgery is unclear.
METHODS: With this technique, 20 patients undergoing bypass surgery were
continuously monitored from inception to discontinuation of bypass.
RESULTS: Embolic signals were detected in all patients. Of all embolic
signals, 34% were detected as aortic cross-clamps were removed, and another
24% as aortic partial occlusion clamps were removed. Only 5% were detected
at inception of bypass. Rates for embolization were 15.15 embolic signals
per minute at cross-clamp removal, 10.9 embolic signals per minute at
partial occlusion clamp removal, and fewer than 3 embolic signals per
minute at other times. Correlation was found between the number of emboli,
severity of aortic atheromatosis, and neurocognitive deterioration.
CONCLUSIONS: The majority of emboli detected during coronary artery bypass
grafting are associated with the release of clamps. Clamp manipulation may
lead to release of aortic atheromatous debris. These emboli may be relevant
to neurocognitive outcome.
ARTICLES
Cerebral emboli detected during bypass surgery are associated with clamp removal
Department of Neurology, Cornell University Medical College, New York Hospital, NY 10021.
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S. Sylivris, C. Levi, G. Matalanis, A. Rosalion, B. F. Buxton, A. Mitchell, G. Fitt, D. B. Harberts, M. M. Saling, and A. M. Tonkin Pattern and significance of cerebral microemboli during coronary artery bypass grafting Ann. Thorac. Surg., November 1, 1998; 66(5): 1674 - 1678. [Abstract] [Full Text] [PDF]
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F. W. Mohr, V. Falk, A. Diegeler, T. Walther, J. A. M. van Son, R. Autschbach, and H. G. Borst Minimally Invasive Port-Access Mitral Valve Surgery J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 567 - 571. [Abstract] [Full Text]
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A. Jacobs, M. Neveling, M. Horst, M. Ghaemi, J. Kessler, H. Eichstaedt, J. Rudolf, P. Model, H. Bonner, E. R. de Vivie, et al. Alterations of Neuropsychological Function and Cerebral Glucose Metabolism After Cardiac Surgery Are Not Related Only to Intraoperative Microembolic Events Stroke, March 1, 1998; 29(3): 660 - 667. [Abstract] [Full Text] [PDF]
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S. K. Brakken, D. Russell, R. Brucher, M. Abdelnoor, and J. L. Svennevig Cerebral Microembolic Signals During Cardiopulmonary Bypass Surgery : Frequency, Time of Occurrence, and Association With Patient and Surgical Characteristics Stroke, October 1, 1997; 28(10): 1988 - 1992. [Abstract] [Full Text]
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D. Barbut, Y.-W. Lo, G. S. Hartman, F.-S. F. Yao, R. R. Trifiletti, D. N. Hager, R. B. Hinton, J. P. Gold, and O. W. Isom Aortic Atheroma Is Related to Outcome but Not Numbers of Emboli During Coronary Bypass Ann. Thorac. Surg., August 1, 1997; 64(2): 454 - 459. [Abstract] [Full Text]
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E. J. Heyer, D. C. Adams, E. Delphin, D. J. McMahon, S. D. Steneck, M. C. Oz, R. E. Michler, and E. A. Rose CEREBRAL DYSFUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING DONE WITH MILD OR MODERATE HYPOTHERMIA J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 270 - 277. [Abstract] [Full Text]
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D. Barbut, F.-S. F. Yao, Y.-W. Lo, R. Silverman, D. N. Hager, R. R. Trifiletti, and J. P. Gold Determination of Size of Aortic Emboli and Embolic Load During Coronary Artery Bypass Grafting Ann. Thorac. Surg., May 1, 1997; 63(5): 1262 - 1267. [Abstract] [Full Text]
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D. Barbut, Y.-W. Lo, J. P. Gold, R. R. Trifiletti, F. S. Frank Yao, D. N. Hager, R. B. Hinton, and O. W. Isom Impact of Embolization During Coronary Artery Bypass Grafting on Outcome and Length of Stay Ann. Thorac. Surg., April 1, 1997; 63(4): 998 - 1002. [Abstract] [Full Text]
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R. B. Libman, E. Wirkowski, M. Neystat, W. Barr, S. Gelb, and M. Graver Stroke Associated With Cardiac Surgery: Determinants, Timing, and Stroke Subtypes Arch Neurol, January 1, 1997; 54(1): 83 - 87. [Abstract] [PDF]
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A. S. Keats and S. Slogoff Perfusion pressure and coronary bypass J. Thorac. Cardiovasc. Surg., July 1, 1996; 112(1): 204 - 205. [Full Text]
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D. Barbut, F.S. Yao, D.N. Hager, P. Kavanaugh, R.R. Trifiletti, and J.P. Gold Comparison of Transcranial Doppler Ultrasonography and Transesophageal Echocardiography to Monitor Emboli During Coronary Artery Bypass Surgery Stroke, January 1, 1996; 27(1): 87 - 90. [Abstract] [Full Text]
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N. E. Alexis, W. D. Dietrich, E. J. Green, R. Prado, and B. D. Watson Nonocclusive Common Carotid Artery Thrombosis in the Rat Results in Reversible Sensorimotor and Cognitive Behavioral Deficits Stroke, December 1, 1995; 26(12): 2338 - 2346. [Abstract] [Full Text]
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